Extreme risk - the new corporate proposition for physicians

Article Abstract:

Managed health care corporations create financial incentives for doctors which adversely affect care and are unnecessary to control costs. These incentives arise as doctors' salaries are connected to their reduction of costs and ability to raise corporate profit. A 1995 study showed that many health maintenance organizations pay physicians according to how they reduce costs and service utilization. Another 1995 study suggests there has been an increase in the number of physician groups that assume the risks and responsibilities of managing and providing care by being paid through capitation. However, the study also found that utilization of services in these groups is extremely low. Thus having doctors share the financial risks does not change the incentives that cause doctors to make fewer referrals and select low-risk, healthy patients. In addition, the physician groups that do not sell their assets to investors will run out of capital. The solution may lie in paying physicians regular salaries in non-profit health plans that the community controls.

Physicians, Medical professions, Managed care plans (Medical care)

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Denial of care to illegal immigrants: Proposition 187 in California

Article Abstract:

California doctors should do whatever they can to reduce the impact of Proposition 187. This law, passed by California voters in 1994, denies non-emergency health care to illegal immigrants and requires health care facilities to report such patients to the Immigration and Naturalization Service. This reduces doctors' autonomy and violates patient confidentiality. In addition, it creates serious public health problems because untreated patients may transmit infectious diseases. All doctors are trained to provide medical care regardless of the patient's status or ability to pay. If the courts uphold Proposition 187, doctors can draft guidelines to reduce its damage, insist that only the patient's immigration status be revealed to government authorities and provide appropriate treatment while the patient's status is being determined.

Care and treatment, Political aspects, Illegal immigrants, Medical ethics

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Improving care near the end of life: why is it so hard?

Article Abstract:

There are several problems with the care of the terminally ill, many that involve physicians. Physicians need to improve their communications skills to determine what type of care the patient desires. Some patients do not want aggressive care, yet they are put on mechanical ventilation in the intensive care unit. Physicians should discuss the patient's prognosis and the option of cardiopulmonary resuscitation. If the patient refuses medical intervention, the information should be recorded and the directive should be carried out. Pain control also should be improved for the terminally ill, who often suffer severely in the days before they die. Physicians should modify their practices and behavior to improve care for people nearing the end of their lives.

Analysis, Physician and patient, Physician-patient relations, Terminal care, Right to refuse treatment, Treatment refusal

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