Columbia/HCA and the Resurgence of the for-Profit Hospital Business (Part 2 of 2)
New England Journal of Medicine. 1996 Aug 8; 335(6): 446-451.
In the near future, we will see either a growing convergence in the behavior of nonprofits and for-profits or a sharper delineation between institutions with a community purpose and those driven by the bottom line. Convergence would intensify the pincer pressure on medicine from managed-care payers on the one side and profit-maximizing hospitals on the other. It would probably further squeeze patient care and physician autonomy. It would increase the tension between doctors' professional and entrepreneurial roles. It would make a self-fulfilling prophecy of Columbia's often repeated claim that there is no effective difference between the two sectors and that tax exemptions are a waste of public money....Columbia/HCA insists that medicine is a business, and increasingly imposes its rules on the competitive game. If nonprofits are to retain their claim to fiscal and moral difference, they will need not only to match the chains lawyer for lawyer, ad for ad, market strategy for market strategy, and cost saving for cost saving, but also to be clearer about their own mission. And society, through better regulation and disclosure, will need to fashion clearer ground rules -- or cede them to the market.
Administrators; Autonomy; Coercion; Community Services; Conflict of Interest; Disclosure; Doctors; Economics; Entrepreneurship; Ethics; Government; Government Regulation; Health; Health Care; Health Personnel; Hospitals; Incentives; Institutional Ethics; Legal Aspects; Managed Care Programs; Medicine; Misconduct; Moral Obligations; Managed Care; Organization and Administration; Patient Care; Physicians; Political Activity; Proprietary Hospitals; Regulation; State Government; Trends;
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Kuttner, Robert (1996-08-01)This two-part article addresses the medical, ethical, and public-policy issues posed by the resurgence of for-profit chains and their acquisition of nonprofit community hospitals. The prime case in point is Columbia/HCA ...