Gaming the System: Dodging the Rules, Ruling the Dodgers
Morreim, E. Haavi
Archives of Internal Medicine. 1991 Mar; 151(3): 443-447.
Although traditional obligations of fidelity require physicians to deliver quality care to their patients, including to utilize costly technologies, physicians are steadily losing their accustomed control over the necessary resources. The "economic agents" who own the medical and monetary resources of care now impose a wide array of rules and restrictions in order to contain their costs of operation. However, physicians can still control resources indirectly through "gaming the system," employing tactics such as "fudging" that exploit resource rules' ambiguity and flexibility to bypass the rules while ostensibly honoring them...Though tempting, gaming is morally and medically hazardous. It can harm patients and society, offend honesty, and violate basic principles of contractual and distributive justice. It is also, in fact, usually unnecessary in securing needed resources for patients. More fundamentally, we must reconsider what physicians owe their patients....
Beneficence; Biomedical Technologies; Contracts; Deception; Diagnosis; Economics; Ethics; Financial Support; Fraud; Harm; Health; Health Care; Health Care Delivery; Health Insurance; Health Maintenance Organizations; Home Care; Hospitals; Indigents; Insurance; Justice; Legal Aspects; Medical Ethics; Medical Fees; Medicine; Misconduct; Moral Obligations; Moral Policy; Obligations to Society; Organizations; Patient Advocacy; Patient Care; Patients; Peer Review; Physician Patient Relationship; Physicians; Preventive Medicine; Public Policy; Remuneration; Resource Allocation; Review; Risks and Benefits; Stigmatization; Trust; Virtues;
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Morreim, E. Haavi (1985-06)Cost containment in health care poses enormous challenges to traditional medical values. Morreim considers the effect on physicians of the federal government's Diagnosis Related Groups (DRG) prospective reimbursement plan ...