In The Wall Street Journal, Clayton Christensen, Jeffrey Flier and Vineeta Vijayaraghavan say that the Affordable Care Act's updated versions of HMOs are based on flawed assumptions about doctor and patient behavior.
Defend physicians’ ethical responsibilities to patients
It will be more and more challenging for physicians to maintain professional ethics when ethics collide with economic interests.
Our evolving health care system structure is constantly emphasizing lowering costs. So-called “quality-based measures” may give physicians perverse incentives to dismiss patients who do not meet target measures, and they may be asked to ration health care resources in ways that place employers’ or Wall Street’s needs above those of the individual patient’s.
Furthermore, hospitals and other entities will continue to look toward employing physicians so they can consolidate market share and capture the payment stream for physician services. Physicians who accept employment opportunities with hospitals and other practice models not owned and controlled by physicians could find their clinical autonomy threatened.
The ability of physicians to act in their patients’ best interests must not be compromised by outside — and sometimes competing — economic, political, or social pressures. Yet lawmakers and other nonphysicians are ever more inclined to delineate the details of the interaction between physicians and patients. Physicians increasingly face nonphysicians’ attempts to mandate what information, tests, procedures, and treatments they must — or must not — provide to their patients.
The practice of medicine is founded upon ethics that arise from the imperative to alleviate suffering and to care for patients. According to the AMA Code of Medical Ethics, “The relationship between patient and physician is based on trust and gives rise to physicians’ ethical obligations to place patients’ welfare above their own self-interest and above obligations to other groups, and to advocate for their patients’ welfare.”