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1、Luxury Primary Care,Academic Medical Centers, and the Erosion of Science and Professional EthicsMartin Donohoe, MD, FACPLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Luxury Primary CarenIntroductionnSourcesnResearchLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心
2、和侵蚀Academic Medical Centers Hurting FinanciallynUS health care crisisnCosts associated with medical trainingnDisproportionate share of complex and/or uninsured patientsLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Academic Medical Centers Hurting FinanciallynErosion of infrastru
3、cturenShrinking funding basenIncreased competition with more efficient private and community hospitalsLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Single Specialty Hospitalsn nOver 100 nationwideOver 100 nationwiden nOften physician-ownedOften physician-ownedn nProblems:Problem
4、s:n nCherry pick healthier patients with good coverageCherry pick healthier patients with good coveragen nNo ERNo ERn nAcademic and community hospitals depleted of income Academic and community hospitals depleted of income stream used to cross-subsidize indigent care, ER, trauma, stream used to cros
5、s-subsidize indigent care, ER, trauma, burn wards, and mental health careburn wards, and mental health caren nIncentives for overtreatmentIncentives for overtreatmentn n1/3 may violate Medicares conditions for participation1/3 may violate Medicares conditions for participationLuxuryPrimaryCareAcadem
6、icMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Medical Tourismn nUS citizens traveling abroad for care (750,000 in 2007, expected 1 million in 2010)n nInsurance plans increasingly covern nTransplant tourismn nBlack market for organs (1/5 of all kidneys transplanted worldwide each year)LuxuryPrimaryCare
7、AcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Competitive Strategiesn nIncrease alliances with pharmaceutical and biotech industriesn nRecruit wealthy, non-U.S. citizens as patientsn nOpen hospitals in other countriesLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Competitive
8、Strategiesn nMore aggressive billing practices / charging the uninsured higher pricesn nResult: class action suitsn nIncrease cash services (botox treatments, cosmetic surgery) and re-imburseable, covered services (e.g., cardiac catheterization, bone density testing)LuxuryPrimaryCareAcademicMedicalC
9、entersandtheErosion奢侈初级保健学术医疗中心和侵蚀Competitive Strategiesn nCut back on uncovered services: e.g., ER staffingn n“Triaging out” redirecting low acuity patients to ER to “other facilities”n nUniversity of Chicago overturned policy in University of Chicago overturned policy in response to protests (2009
10、)response to protests (2009)n nACEP and AAEM opposes such policiesACEP and AAEM opposes such policiesLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Competitive Strategiesn nAdvertisingn nOften promote high-paying, unproved, or cosmetic servicesn nArch Int Med 2005;165:645-51n nOu
11、tsource radiology/transcription services to physicians in developing worldn ne.g., MGH and Yale X-rays India (they have since ended agreements)LuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Competitive Strategiesn nPay sports teams for privilege of being team doctors (in return f
12、or free publicity)n nMethodist Hospital Houston Texansn nNYU Hospital for Joint Diseases NY Metsn nDevelop luxury primary care clinicsn nAKA “executive health clinics”, “boutique medicine”, “concierge care”, “VIP clinics”LuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Recruitment
13、of Wealthy Non-US Citizensn n70,000 patients/yrn nEstimated 1-2% of hospitals revenuesn nNumber estimated to quadruple in next few yearsn nRecruitment worldwiden nHospitals forming consortia to target certain countries, including those with national health plansLuxuryPrimaryCareAcademicMedicalCenter
14、sandtheErosion奢侈初级保健学术医疗中心和侵蚀Recruitment of Wealthy Non-US CitizensnDoctors sent on overseas speaking and recruitment toursnPatients offered rapid access to state-of-the-art careLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Recruitment of Wealthy Non-US Citizensn nPayment at “re
15、tail rate,” well above what government and private insurance reimbursen nImmediate access to face-to-face translatorsn nOnly spottily available to uninsured, non-English speaking patientsLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Recruitment of Wealthy Non-US Citizensn nPatie
16、nts have not paid taxes in support of medical education and health care subsidiesn nThe federal government spends about $10 billion/yr to pay medical schools and teaching hospitals for medical education and trainingn nState and local governments provide $2-3 billion/yr in additional subsidiesLuxuryP
17、rimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Recruitment of Wealthy Non-US CitizensnHealth needs may not be as pressing (and are usually more costly) than the needs of those living in poverty in their home countriesLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Rec
18、ruitment of Wealthy Non-US Citizensn nAcademic medical centers often refuse non-emergent care to non-US citizen refugees and undocumented aliensn nReason: Fear of depletion of financial resourcesn nCosts of care itselfn nDevelopment of informal referral baseLuxuryPrimaryCareAcademicMedicalCentersand
19、theErosion奢侈初级保健学术医疗中心和侵蚀Boutique Medicinen nRetainer Fee Medical Practicen nLarge/expensive vs. small/less expensive (sometimes for the uninsured; not the focus of this talk)n nPremier Care, Valet Care, VIP Care, Gold Care, Platinum Caren nLuxury Primary Care / Executive Health ClinicsLuxuryPrimary
20、CareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Boutique Medicinen nRetail outlet clinicsn nMedi-Spasn nTravel medicine clinics for exotic destinationsn nDirect sales to patients of health and nutritional products, home laboratory and genome testing kitsLuxuryPrimaryCareAcademicMedicalCentersa
21、ndtheErosion奢侈初级保健学术医疗中心和侵蚀Factors Which Might Encourage Retainer Fee Medical PracticeJ Clin Ethics 2005(Spring):72-84nTight office schedules, long delays for appointments, shorter visit lengthsnAuthorization requirements of insurance companies, HMOs, and MedicareLuxuryPrimaryCareAcademicMedicalCent
22、ersandtheErosion奢侈初级保健学术医疗中心和侵蚀Factors Which Might Encourage Retainer Fee Medical PracticenInsufficient time to return phone callsnCongested ERs, with long delays for patients with minor illnesses who are unable to access PCPnPatients referred to specialists for problems that do not necessarily requ
23、ire a specialists careLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Factors Which Might Encourage Retainer Fee Medical Practicen nFrequent changes in PCP, abetted by:n nHospitalist movementHospitalist movementn nEmployers seeking cheaper plans, which provide Employers seeking ch
24、eaper plans, which provide narrower range of coveragenarrower range of coveragen nInsurance company de-listing of physicians based Insurance company de-listing of physicians based on economic criteriaon economic criterian nPhysician extenders (NPs and Pas)Physician extenders (NPs and Pas)n nLess tim
25、e for patient-care advocacyLess time for patient-care advocacyn nLess time for CMELess time for CMELuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Luxury Primary Care ClinicsnSome are solo and small group practicesnSome affiliated with large corporationsnExecutive Health Registryn
26、Executive Health Exams InternationalnOneMDLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Luxury Primary Care Clinicsn nMDVIPn nMission: “Assist doctors in transitioning from traditional to retainer-style practices”n nPhenomenal growth raten n24 practices in 7 states, with 40 more
27、 practices in the worksLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Luxury Primary CarenProfessional Organization:nAmerican Society of Concierge Physicians (ASCP) nSociety for Innovative Medical Practice Design (SIMPD)LuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术
28、医疗中心和侵蚀Luxury Primary Care Clinicsn nUniversity-affiliated:n nMayo Clinic (3000/yr); Cleveland Clinic (3500/yr); MGH (1950/yr)n nJohns Hopkins, Penn, New York Presbyterian, Washington University, UCSF, UCLA, many othersLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Luxury Primary
29、 Care ClinicsnAnnual exams last 1-2 daysnAverage baseline cost $2000 - $4000 per visit for baseline packagen nAdditional tests extran n(range $1500 - $20,000)LuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Luxury Primary Care ClinicsnPhysicians available 24/7/365 by phone/pager fo
30、r additional feenPatient/physician ratios 10-25% of typical managed care levelsLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Luxury Primary Care Clinics:Perks and Pamperingn nTests, subspecialty consultations available same dayn nPatients jump the queue, sometimes delaying tests
31、 on other patients with more appropriate and urgent needsn nSpecial shirtsn nGold cardsLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Luxury Primary Care Clinics:Perks and Pamperingn nVaccines (in short supply elsewhere) always availablen nValet parkingn nEscortsn nPlush bathrobe
32、sLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Luxury Primary Care Clinics:Perks and Pamperingn nOak-paneled waiting rooms with high-backed leather chairs and fine artn nTVs, computers, fax machinesn nBuffet meals, herb teasn nSaunas and massagesLuxuryPrimaryCareAcademicMedicalC
33、entersandtheErosion奢侈初级保健学术医疗中心和侵蚀Luxury Primary Care Clinicsn nCapitalize on widespread dissatisfaction with managed care and too-busy physicians with inadequate time to provide comprehensive care and counselingn nAppeal to patients desires to receive the latest high-tech diagnostic and therapeutic
34、 interventionsLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Clients / Patientsn nPredominantly healthy / asymptomaticn nUS and non-US citizensn nCorporate executivesn nSome from companies with extensive histories of Some from companies with extensive histories of harming health
35、through environmental pollution, harming health through environmental pollution, tobacco salestobacco salesn nSome from insurance companies, whose own Some from insurance companies, whose own policies increasingly limit the coverage of sick policies increasingly limit the coverage of sick individual
36、s, including their own lower level individuals, including their own lower level employeesemployeesLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Clients / Patients:Upper Managementn nDisproportionately white males:n nData available from one Executive Health Programn nWomen:n n46%
37、 of the workforcen nHold 2% of senior-level management positions in Fortune 500 Companiesn nLower SES of non-CaucasiansLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Luxury Primary Care:Marketingn nDirected at the heads of large and small companiesn nHospitals hope high-level man
38、agers will steer their companies lucrative health care contracts toward the institution and its providersn nSome programs give discounted rates in exchange for a donation to the hospitalLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Luxury Primary Care:Marketingn nPromotional mat
39、erials imply that wealthy executives are busier and lead more hectic lives than othersn nWe cater to “the busy executive” who “demands We cater to “the busy executive” who “demands only the best”only the best”n nIn fact, lower SES patients lives are often busier and their health outcomes worse, rend
40、ering them in greater need of efficient, comprehensive careLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Programs are Secretiven nStating that I was a physician researching the phenomenon of LPC clinics, I wrote and then called 13 LPC clinicsn nOnly one person at one clinic woul
41、d answer basic questions relating to the # of providers, involvement of residents, funding, cross-subsidizationLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀LPC Clinics and The Erosion of SciencenMany tests not clinically- or cost-effectivenPercent body fat measurementsnChest X
42、rays in smokers and non-smokers over age 35 to screen for lung cancerLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀LPC Clinics and The Erosion of Sciencen nElectron-beam CT scans and stress Electron-beam CT scans and stress echocardiograms for coronary artery diseaseechocardiogr
43、ams for coronary artery diseasen nRadiation from a full-body CT scan comparable to dose Radiation from a full-body CT scan comparable to dose with increased cancer mortality in low-dose atomic with increased cancer mortality in low-dose atomic bomb survivors (Radiology 2004;232:735-8)bomb survivors
44、(Radiology 2004;232:735-8)n nRaise cancer riskRaise cancer riskn n2008: TX legislation proposed to require insurance 2008: TX legislation proposed to require insurance companies to covercompanies to covern nAbdominal-pelvic ultrasounds to screen for liver Abdominal-pelvic ultrasounds to screen for l
45、iver and ovarian cancerand ovarian cancerLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀LPC Clinics and The Erosion of Sciencen nOther tests controversialn nGenetic testingn nMammograms in women beginning at age 35n nFalse positive tests may lead to unnecessary investigations, hi
46、gher costs and needless anxietyn nAnd increased profits to the clinic.LuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Direct Marketing of High-Tech Tests to Patientsn nAmeriscan:n nFull body scans: “detect over 100 life-threatening diseases in the arteries, heart, lungs, liver and
47、 other major vital organs before its too late”n nMRI breastscreens: detect “nearly 100% of all breast cancers”n nVirtual colonoscopiesLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀The Use of Clinically-Unjustifiable Testsn nErodes the scientific underpinnings of medical practice
48、n nSends a mixed message to trainees about when and why to utilize diagnostic studiesn nRuns counter to physicians ethical obligations to contribute to the ethical stewardship of health care resourcesLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀The Use of Clinically-Unjustifiab
49、le Testsn nSome might argue that if a patient is willing to pay for a scientifically-unsupported test that she should be allowed to do so. However,n n“Buffet” approach to diagnosis makes a mockery of evidence-based medical caren nDiverts hardware and technician time away from patients with more appr
50、opriate and possibly urgent indications for testingLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Ethics/Justice:Treating Patients from OverseasnThe greatest good for the greatest numbernLiver transplant for wealthy foreign banker vs. treating undocumented farm laborers for TB an
51、d pesticide-related diseasesLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Ethics/Justice:Treating Patients OverseasnDeploying medical students and physicians overseas to provide care and educate local practitioners in the care of respiratory and water-borne infectious diseasesnK
52、ill thousands worldwide each dayLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Ethics/JusticenMarket forces have spurred for-profit health care companies to export the most inefficient, unjust elements of American medicine to the developing worldLuxuryPrimaryCareAcademicMedicalCe
53、ntersandtheErosion奢侈初级保健学术医疗中心和侵蚀Ethics/Justicen nMigration of medical professionals from the developing world, where they were trained at public expense, to the US further depletes health care resources in poor countries and contributes to increasing inequities between rich and poor nationsn nUS pa
54、tients going abroad for procedures; medical tourism; supported by many insurance companiesLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀The Medical Brain Drainn n1998 UN/WHO Study: 56% of all migrating doctors flow from developing to developed nations, while only 11% migrate in
55、the opposite directionn n2007: WHO estimates 2.4 million too few physuicians, nurses, and midwives to provide essential health services to developing worldn nU.S. largest “consumer” of health workers from the developing worldn nEven greater imbalance for nursesLuxuryPrimaryCareAcademicMedicalCenters
56、andtheErosion奢侈初级保健学术医疗中心和侵蚀The Medical Brain Drainn nHealth care and financial loss to developing country; gain for developed countryn nExample of “inverse care law”:n nThose countries that need the most health care resources are getting the leastLuxuryPrimaryCareAcademicMedicalCentersandtheErosion
57、奢侈初级保健学术医疗中心和侵蚀LPC Clinics and The Erosion of Professional Ethicsn nPublic contributes substantially to the education and training of new physiciansn nMay object to doctors limiting their practices to the wealthy, not accepting Medicare or Medicaid patientsn nIncreases health disparities between ric
58、h and poorLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀LPC Clinics and The Erosion of Professional Ethicsn nAlternatively, debt-ridden physicians might justify limiting their practices to the wealthy by claiming a right to freely choose where they practice and for whom they car
59、en nLimits: HIV patients, racial prejudiceLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀LPC Clinics and The Erosion of Professional Ethicsn nAcademic medical centers justifications for LPC clinics:n nEnhance plurality in health care delivery; increase choices available to health
60、 care consumersn nCross-subsidization of training or indigent care programsn nEvidence lacking due to secrecyn nVariant of “trickle down economics”LuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀LPC Clinics and The Erosion of Professional Ethicsn nAMA Guidelines:n nPhysicians swit
61、ching to LPC practices must facilitate the transfer of patients who dont pay retainers to other physiciansn nShifts un- and poorly-compensated patient care onto fewer providers; risks domino effectLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀LPC Clinics and The Erosion of Profe
62、ssional Ethicsn nAMA Guidelines:AMA Guidelines:n nIf non-retainer care is not locally available, If non-retainer care is not locally available, physicians may be obligated to continue to care for physicians may be obligated to continue to care for patients without charging them a premiumpatients wit
63、hout charging them a premiumn nPhysicians with boutique practices are also still Physicians with boutique practices are also still obligated to provide care to patients in needobligated to provide care to patients in needn n“Robin Hood practices”“Robin Hood practices”n nRetainer-style practices shou
64、ldnt be marketed as Retainer-style practices shouldnt be marketed as providing better diagnostic and therapeutic providing better diagnostic and therapeutic servicesservicesLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Ethics/Justicen n45 million uninsured patients in USn nMilli
65、ons more underinsuredn nRemain in dead-end jobsn nGo without needed prescriptions due to skyrocketing drug pricesLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Ethics/Justicen nPublic and charity hospitals closingn nRetail outlet clinics increasing (Wal Mart, CVS, etc.)n nMechani
66、sm for increasing stores profits through sales of merchandise, over-priced pharmaceuticalsn nLess likely to be located in underserved areasn nNo guarantee of continuity of careLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Headline from The OnionUninsured Man Hopes His Symptoms D
67、iagnosed This Week On HouseLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Ethics/Justicen nUS ranks near the bottom among westernized nations in life expectancy and infant mortalityn n20-25% of US children live in povertyn nGap between rich and poor wideningn nRacial inequalities
68、 in processes and outcomes of care persistLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Ethics/Justicen nWidening disparity between what hospitals charge uninsured and self-pay patients compared with insured patientsn nPrivate hospitals charging more than public hospitals for en
69、d-of-life caren nNo effect on outcomes, quality of lifeNo effect on outcomes, quality of lifeLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Meanwhile, Outside the USn nOne billion people lack access to clean drinking watern n3 billion lack adequate sanitation servicesn nHunger ki
70、lls as many individuals in two days as died during the atomic bombing of HiroshimaLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Physician Dissatisfaction/Cynicism/Erosion of Professionalismn nIncreasing dissatisfaction and cynicism among patients, practicing physicians and train
71、eesn nEducators increasingly concerned over adequacy of trainees humanistic and moral developmentLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Ethical DistortionsnDoctors offering varying levels of testing and treatment based on patients ability to payn nJ Gen Int Med 2001;16:41
72、2-8.nSurprise?LuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Doctor-Patient Communication re Out-of-Pocket Costsn n15-20% of U.S. health care costs paid by patients out-of-pocketn nPhysician-patient communication hindered by discomfort (patients) and perceived lack of time/nihili
73、sm (physicians)n nRelevant/importantLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Ethical DistortionsnA sizeable minority of physicians admit to “gaming the system” by manipulating reimbursement rules so their patients can receive care the doctors perceive is necessaryn nJAMA 20
74、00;238:1858-65n nArch Int Med 2002;162:1134-9LuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Ethical Distortionsn of the public sanctions deception; of those who believe doctors have inadequate time to appeal coverage decisionsn nAnn Int Med 2003;138:472-5n nAm J Bioethics 2004;4(
75、4):1-7LuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Conclusion:Erosion of Sciencen nLPC clinics offer care based on unsound science and non-evidence-based medicinen nMotives:n nMarketabilityn nProfitabilityn nPatient satisfaction/demandn nPotential for harmLuxuryPrimaryCareAcade
76、micMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Conclusion:Erosion of EthicsnThe promotion of LPC clinics and the recruitment of wealthy foreigners by academic medical centers erodes fundamental ethical principles of equity and justice and promotes an overt, two-tiered system of health careLuxuryPrimar
77、yCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀SolutionsnRenounce the marketplace as dominant standard or value in medicinenDivert intellectual and financial resources to more equitable and just investments in community and global healthLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初
78、级保健学术医疗中心和侵蚀SolutionsnClose some academic medical centersnConsolidate redundant educational and clinical programs in nearby teaching hospitalsLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Solutionsn nReduce costs throughn nQuality improvement programsn nImproved governance and d
79、ecision-makingn nAugmenting philanthropic contributionsn nIncreasing alliances with industry?n nRisks undue corporate influence on academic institutions agendasLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Solutionsn nImproved training and practice of professionalism in medicine
80、n nHeal schism between medicine and public healthn nService-oriented learning, research-based activist courses, volunteerism, political activismLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀SolutionsnHistory and literaturenRole models/mentorsnRefocus ethics trainingLuxuryPrimary
81、CareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Solutionsn nEmpathic and equal provision of care to all individuals, regardless of insurance status, financial resources, race or sexn nConfront and work to abolish the reality of rationing; promote equal access and care in all spheres of medicin
82、eLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀SolutionsnEducate public and policymakers regarding the important roles they play in research, education and patient carenParticularly in terms relevant to individuals and their familiesLuxuryPrimaryCareAcademicMedicalCentersandtheE
83、rosion奢侈初级保健学术医疗中心和侵蚀SolutionsnCommunicate these ideas to business leaders, government representatives, and purchasers of health carenparticularly deans, hospital presidents and department chairsLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Solutionsn nSociety/legislators should
84、 provide increased funding for the education and training of medical students and resident physicians and for the continued health of vital academic medical centers, to allow them to carry out their missions of education, research, and patient care, particularly for the underservedLuxuryPrimaryCareA
85、cademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Referencesn nDonohoe MT. “Standard vs. luxury care,” in Donohoe MT. “Standard vs. luxury care,” in Ideological Debates in Family MedicineIdeological Debates in Family Medicine, S , S Buetow Buetow and T Kenealy, Eds. (New York, Nova Science and T Kene
86、aly, Eds. (New York, Nova Science Publishers, Inc., 2007). Available at Publishers, Inc., 2007). Available at n nDonohoe MT. Elements of professionalism for a Donohoe MT. Elements of professionalism for a physician considering the switch to a retainer practice. physician considering the switch to a
87、retainer practice. In In Professionalism in Medicine: The Case-based Professionalism in Medicine: The Case-based Guide for Medical StudentsGuide for Medical Students, Editors: Spandorfer, , Editors: Spandorfer, Pohl, Rattner, and Nasca (Cambridge University Pohl, Rattner, and Nasca (Cambridge Univer
88、sity Press, 2008, in press).Press, 2008, in press).LuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Referencesn nDonohoe MT. Luxury primary care, academic Donohoe MT. Luxury primary care, academic medical centers, and the erosion of science and medical centers, and the erosion of s
89、cience and professional ethics. J Gen Int Med 2004;19:90-94. professional ethics. J Gen Int Med 2004;19:90-94. Available at Available at n nDonohoe MT. Retainer practice: Scientific issues, Donohoe MT. Retainer practice: Scientific issues, social justice, and ethical perspectives. American social ju
90、stice, and ethical perspectives. American Medical Association Virtual Mentor 2004 Medical Association Virtual Mentor 2004 (April);6(4). Available at (April);6(4). Available at LuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀Contact InformationPublic Health and Social Justice Websitemartindonohoephsj.orgLuxuryPrimaryCareAcademicMedicalCentersandtheErosion奢侈初级保健学术医疗中心和侵蚀
