Conflicting interests in private hospital care

O'Loughlin, Mary Ann

doi:10.1071/ah020106

Cited by 7 publications

(9 citation statements)

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“…3 The legitimate profit motive can influence private clinics to promote or even institutionalize certain behaviours that may go against the primary interests of patients, thus creating troubling conflicts of interest for health professionals and managers. [4][5][6][7] For example, unlike physiotherapists working in the public sector who are paid a salary (based on an hourly rate), those in PP are most often paid according to the number of patients they see per day (i.e., a set amount per patient). This payment structure can push physiotherapists in PP to find ways of keeping patients longer (i.e., for more sessions), seeing them more frequently, or treating more patients at the same time so as to ensure more stable revenue for the clinic and, by extension, their own professional income.…”

Section: For Canadian Physiotherapists Private Practice (Pp)mentioning

confidence: 99%

Ethical Issues Raised by Private Practice Physiotherapy Are More Diverse than First Meets the Eye: Recommendations from a Literature Review

Hudon

Drolet

Williams‐Jones

2015

Physiotherapy Canada

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Purpose: Physiotherapy in private practice differs from physiotherapy practised in a public setting in several ways, the most evident of which is the for-profit nature of private physiotherapy clinics; these differences can generate distinct and challenging ethical issues. The objectives of this article are to identify ethical issues encountered by physiotherapists in private practice settings and to identify potential solutions and recommendations to address these issues. Method: After a literature search of eight databases, 39 studies addressing ethical issues in a private practice context were analyzed. Results: A total of 25 ethical issues emerging from the included studies were classified into three main categories: (1) business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time affecting quality of care); (2) professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) patients' rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs. patient autonomy, informed consent). Recommendations as to how physiotherapists could better manage these issues were then identified and categorized. Conclusions: The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported-through education, research, and good governance-in providing the best possible care for their patients.Key Words: ethics, professional; private practice; private sector. RÉ SUMÉObjet : La pratique privé e de la physiothé rapie diffè re de la pratique de la physiothé rapie dans un é tablissement public pour plusieurs raisons, la plus é vidente é tant la nature lucrative des cliniques privé es. Ces diffé rences soulè vent des questions d'é thique uniques et é pineuses. Le pré sent article vise à cerner les enjeux é thiques qui se pré sentent aux physiothé rapeutes qui travaillent en pratique privé e et à identifier des solutions et des recommandations é ventuelles. Mé thode : À la suite d'une revue de la litté rature dans huit bases de donné es, trente-neuf é tudes portant sur les enjeux é thiques dans le contexte de la pratique privé e ont é té analysé es. Ré sultats : Au total, vingt-cinq enjeux é thiques dé coulant des é tudes retenues ont é té classé s en trois principales caté gories : (1) les enjeux commerciaux et é conomiques (p. ex., les conflits d'inté rê ts, l'iniquité dans le contexte de la gestion des soins, le manque de temps influant sur la qualité des soins); (2) les enjeux professionnels (p. ex., l'autonomie professionnelle, le jugement clinique, l'efficacité des traitements, la conduite professionnelle) et (3) les enjeux lié s aux droits et au bien-ê tre des patients (p. ex., la confidentialité , l'asymé trie du pouvoir, le consentement é clairé ainsi que le paternalisme contre l'autonomie des patients). Des recommandations sur la fac¸on dont les physiothé rapeutes pourraient mieux gé rer ces enjeux ont aussi é té identifié es e...

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Section: For Canadian Physiotherapists Private Practice (Pp)mentioning

confidence: 99%

Ethical Issues Raised by Private Practice Physiotherapy Are More Diverse than First Meets the Eye: Recommendations from a Literature Review

Hudon

Drolet

Williams‐Jones

2015

Physiotherapy Canada

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“…An increased in the number of hospitals, especially private hospitals, would place a premium on the services of these inputs which in turn would raise the costs of hospitals and hence exert a negative effect on efficiency. Related to this is the phenomenon of ‘cherry picking’ by private hospitals, which intensifies competition between hospitals for profitable patients (O’Loughlin, 2002). To the extent that competition for these patients may trigger a form of medical arms race, it is obviously advantageous for public hospitals to be in a market with fewer not more private hospitals 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Following Dalmau‐Matarrodona and Puig‐Junoy (1998), and mindful of the fact that HHI may not adequately capture inequality in hospital market shares, 6 we use both HHI and the number of competing hospitals in the regression model . However, it is possible that the presence of private hospitals may poses different competitive implications on public hospitals, given that private hospitals are likely to have different objective functions and that they can ‘cherry pick’ by attracting profitable patients (O’Loughlin, 2002). To investigate the competitive effects of private hospitals, we further estimate the model using HHI and the number of competing private hospitals as indicators of market concentration.…”

Section: Analytical Frameworkmentioning

confidence: 99%

Hospital Competition, Technical Efficiency and Quality

2011

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This paper studies the link between competition and technical efficiency of public hospitals in the state of Victoria, Australia. It finds a positive relationship between efficiency and competition as measured by the Hirschman–Herfindahl Index (HHI) and a negative relationship when the number of competing private hospitals is used instead of HHI. It also finds that whether or not quality is treated as an endogenous output variable influences the statistical estimates of the link between efficiency and competition. The findings point to possibly undesirable resource allocation effects when public hospitals are made to compete with a large number of private hospitals.

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“…The performance of the for-profits has evidently been controversial. [23][24][25][26][27] During my visit it appeared that these hospitals concentrated on elective, and less expensive procedures. They seemed to avoid the less profitable -but still important -services.…”

Section: The Only Constant Is Changementioning

confidence: 99%

Slaves to economists? A Canadian's view of the Australian health care system

Deber¹

2005

Aust. Health Review

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AN EXPERT IS DEFINED as someone from out of town ? with slides. In health care, such experts also have a tendency to make cross-national comparisons on the basis of a short visit, a few conversations, and a desire to indicate ?lessons learned?.1 In that time-honoured tradition, on the basis of a visit to Melbourne to address the Victorian Healthcare Association, coupled with visits to several local hospitals, this Canadian identified several potential problems arising from Australia?s approach to the public?private mix of hospital services. As Keynes noted, ?The ideas of economists and political philosophers, both when they are right and when they are wrong, are more powerful than is commonly understood. Indeed the world is ruled by little else. Practical men, who believe themselves to be quite exempt from any intellectual influence, are usually the slaves of some defunct economist.?2 Over the past decades, many health care reformers have urged change ? with varying degrees of success ? based on a set of ideas that markets are always right, that competition is both necessary and sufficient for efficiency, and that private is superior to public. One consequence has been a push for a greater role for private delivery of health care services. This is currently hotly contested in Canada, with Australia providing either an exemplary example or a cautionary tale, depending upon ideological proclivities. I was therefore interested in learning more from Australians as to areas of success or failure of the public?private mix in Australia, and this paper highlights my observations.

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Conflicting interests in private hospital care

Abstract: Abstract

Cited by 7 publications

References 1 publication

Ethical Issues Raised by Private Practice Physiotherapy Are More Diverse than First Meets the Eye: Recommendations from a Literature Review

Ethical Issues Raised by Private Practice Physiotherapy Are More Diverse than First Meets the Eye: Recommendations from a Literature Review

Hospital Competition, Technical Efficiency and Quality

Slaves to economists? A Canadian's view of the Australian health care system

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