Physicians' Conflicts of Interest in Japan and the United States: Lessons for the United States
Rodwin, Mark A.
Okamoto, AtoZ (Etsuji)
Journal of Health Politics, Policy and Law. 2000 Apr; 25(2): 343-375.
Japanese health policy shows that even with physician ownership and the absence of for-profit, investor-owned health care, physicians' conflicts of interest thrive. Physician dispensing of drugs and ownership of hospitals and clinics were justified in Japan as ways to avoid commercialization of medicine. Instead, they create physicians' conflicts and fuel patient overuse of services. Japan's Ministry of Health and Welfare (MHW) has responded by introducing per-diem payment, thereby creating incentives to decrease services in ways similar to those of American managed care organizations, but with none of their benefits, such as coordination of care, oversight of physicians' practices, and quality assurance. Although the United States and Japanese health care systems are organized and financed differently there is convergence in the source of their physicians' conflicts and the way they are addressed. The United States is starting to integrate institutional and physician payment and align their incentives, in a traditional Japanese way. In so doing, the United States creates new physicians' conflicts and reduces the role of countervailing incentives and power, an advantage of previous policy. Japan, in turn, has combined incentives to increase and decrease services, thus moving closer to the U.S. policy.
Codes of Ethics; Comparative Studies; Conflict of Interest; Disclosure; Drug Industry; Drugs; Economics; Entrepreneurship; Ethics; Gifts; Government; Government Regulation; Guidelines; Health; Health Care; Health Care Delivery; Health Facilities; Health Insurance; Health Services; Health Services Misuse; Hospitals; Incentives; Industry; Insurance; International Aspects; Law; Legal Aspects; Medical Ethics; Medicine; Misconduct; Managed Care; National Health Insurance; Organizations; Ownership; Physician's Role; Physicians; Private Sector; Professional Organizations; Proprietary Health Facilities; Public Policy; Power; Quality Assurance; Regulation; Trends;
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Rodwin, Marc A. (1989-11-16)As more physicians invest in health care facilities and services, the potential exists for conflicts between physicians' personal financial interests and those of their patients. Professional groups and public policy makers ...