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Biomedical subjects

M A Rodwin

Publications and source records attributed to M A Rodwin.

15 recordsLinked to original sources
PubMed2000

Physicians' conflicts of interest in Japan and the United States: lessons for the United States.

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↗
PubMed1996

Consumer protection and managed care: the need for organized consumers.

Despite its many advantages, managed care creates new problems for consumers. Activists have proposed four types of remedies: (1) increased information and choice; (2) standards for services and marketing; (3) administrative oversight; and (4) procedural due process for complaints. Each approach offers some benefits, but they are insufficient to cope with consumer problems. What is lacking is effective, organized consumer advocacy.

Communication↗
PubMed1992

The organized American medical profession's response to financial conflicts of interest: 1890-1992.

Recent issues of financial conflicts of interest for physicians are illuminated by the history of similar issues from 1890 to 1992 and the response of the organized medical profession to activities like payment of commissions, or "fee splitting," physical ownership of medical facilities, and dispensing of drugs. The medical profession tried to confront these and related conflicts early in the century, in some cases by adopting ethical codes, but was unable to enforce standards of conduct. Since the 1950s, substitutes for fee splitting emerged and were tolerated by the profession. Moreover, its stance became weaker as it abandoned its earlier clear ethical prohibitions and relied instead on subjective standards and, more recently, on disclosure to patients. The medical profession still favors voluntary codes of ethics, setting aspirational goals, promoting a patient-centered ethos, and relying on the good will of individual doctors--tactics for dealing with financial conflicts of interest that this review of recent history suggests are inadequate. Instead, public intervention is required to address these problems.

American Medical Association↗
PubMed1988

Halfway competitive markets and ineffective regulation: the American health care system.

Since the late 1960s the U.S. has attempted to develop a strategy for controlling the rate of growth of health care spending. During the 1970s this strategy relied heavily on various forms of regulation. Some regulatory programs were partially successful in moderating spending increases, but they generated significant opposition--particularly from powerful provider groups, who successfully convinced Congress and the states to dismantle most of the regulatory structure and to substitute various forms of competitive approaches to controlling spending. Some of these competitive strategies have been successful in increasing the efficiency of subsections of our health system. But they too have produced "losers," and the government has been pressured to enter the system to minimize their losses. The net result has been a political stalemate between halfway competitive markets and ineffective regulation. With the rate of health care spending growth near historic levels, it is likely that the 1990s will bring a return to a stronger role for government regulation. But it is unlikely that we are any more willing to tolerate the negative fallout from regulation today than we were in the 1970s, and therefore we predict that the proportion of GNP going to health care will continue to grow throughout the remainder of this century.

Cost Control↗
PubMedDate not supplied

Vested interests.

Explore the source record for details and available documents.

Conflict of Interest↗