The Commercialization of Patient-Related Decision Making in Hospitals

Wehkamp, Karl-Heinz; Naegler, Heinz

doi:10.3238/arztebl.2017.0797

Cited by 41 publications

(29 citation statements)

References 5 publications

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“…[18][19][20] Other studies examined physicians' attitudes related to DRGs regarding ethical issues, conflicts, and commercialization of decision-making. [21][22][23] However, to our knowledge, no study compared perspectives of different hospital workers, from senior executives to practicing clinicians. Information from a range of hospital workers as informants may shed light on changes of hospital culture, behavior and treatment policy that are not captured by quantitative indicators.…”

Section: Key Messagesmentioning

confidence: 99%

Effects of Activity-Based Hospital Payments in Israel: A Qualitative Evaluation Focusing on the Perspectives of Hospital Managers and Physicians

Waitzberg

Quentin

Daniels

et al. 2020

Int J Health Policy Manag

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Background: Since 2010, Israel has expanded the adoption of procedure-related group (PRG) based payments for hospitals. While there is a rich quantitative literature that assesses the effects of payment reforms on efficiency or quality of care, very few qualitative studies have focused on the impacts of diagnosis-related group (DRG)-like payments on hospitals from the perspective of hospital workers as change agents. Methods: We used a qualitative, thematic analysis based on 33 semi-structured in-depth interviews with chief executive officers (CEOs), chief financial officers (CFOs), ward directors and physicians conducted in five public hospitals in Israel, sampled by maximum variation according to hospital characteristics. Results: Interviewees reported that the payment reform led to organizational changes such as increased transparency and enhanced supervision. Interviewees also reported several actions in response to the economic incentives of PRGbased payment. These included (1) shifting activities to afterhours and using operating rooms (ORs) more efficiently to enable increased surgical volumes; (2) reducing costs by shortening lengths of stay and increasing cost-consciousness in procurement; and (3) increasing revenues by improving coding and selecting procedures. Moderating factors reduced the effects of the reform. For example, organizational factors such as the public nature of hospitals or the (un)availability of healthcare resources did not always allow hospitals to increase the number of cases treated. Also, conflicting incentives such as multiple payment mechanisms or underpricing of procedures blurred the incentives of the reform. Finally, managers and physicians have many other considerations that outweigh the economic ones. Conclusion: PRG payments affected the organizational dynamics of hospitals and changed decision-making about admission and treatment policies. However, such effects were moderated by many other factors that should be considered when shaping and analyzing hospital payment reforms.

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Section: Key Messagesmentioning

confidence: 99%

Effects of Activity-Based Hospital Payments in Israel: A Qualitative Evaluation Focusing on the Perspectives of Hospital Managers and Physicians

Waitzberg

Quentin

Daniels

et al. 2020

Int J Health Policy Manag

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“…Aus dieser Entwicklung erwächst jedoch unweigerlich ein Dilemma, konkurrieren doch die eigenen ökonomischen Interessen oft mit der Prämisse, dem [15]. Dem ökonomischen Druck steht entgegen, dass die ärztliche Berufsordnung ( § 2) explizit festlegt, dass "Ärztinnen und Ärzte ihren Beruf nach ihrem Gewissen, den Geboten der ärztlichen Ethik und der Menschlichkeit" ausüben sollen.…”

Section: Diskussionunclassified

“…Andere empirische Untersuchungen belegten das Potential betriebswirtschaftlicher Vorgaben in Verträgen der GeschäftsführerInnen mit den Kliniken, die ärztlichen patientenbezogenen Entscheidungen zu beeinflussen [8,14,20,21]. So verneinten zwar die GeschäftsführerInnen in der Studie von Wehkamp und Naegler eine direkte Einflussnahme auf das ärztliche Handeln, aber einer mittelbaren Einflussnahme auf Grund der ökonomischen Vorgaben wird durchaus zugestimmt [15]. Die Diskrepanz zwischen betriebswirtschaftlichen Vorgaben und der patientenbezogenen Entscheidungsautonomie wird in der Ärzteschaft durchaus als problematisch wahrgenommen.…”

Section: Diskussionunclassified

Ethische Entscheidungen in zunehmend ökonomisierten Krankenhäusern

Alkatout

Strack

Maass

et al. 2020

Wien Med Wochenschr

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Zusammenfassung Werden durch die Ökonomisierung des deutschen Gesundheitssystems medizinische Werte in den Hintergrund gedrängt? Im Rahmen einer Vignettenstudie wurde der Fall einer Verlängerung der Verweildauer einer älteren, noch nicht gänzlich genesenen Patientin vorgestellt. Zunächst sollte über die Verweildauer entschieden werden. Ergänzend hierzu wurde die Relevanz der medizinischen Richtigkeit, Einfühlvermögen für die Patientin und Identifikation mit dem Klinikum erhoben. Die Teilnehmenden (N = 1239) schreiben den Entscheidern die medizinische Korrektheit als wichtigstes Kriterium zu, gefolgt vom Einfühlungsvermögen. Je universalistischer die Werte der befragten Person, umso eher befürwortet sie ein verlängertes Verweilen der Patientin im Krankenhaus. Je sicherheitsorientierter, je weniger tolerant und weniger prosozial, umso eher würde vorzeitig entlassen. Insbesondere fürchten Studierende eine verfrühte Entlassung durch die Entscheidungen des Chefarztes. Dies ist jedoch als unbegründet zu werten. Aus den Zuschreibungen lässt sich interpretieren, dass sich ÄrztInnen im Laufe ihrer Ausbildung eine medizinethisch basierte, deontologisch fundierte Entscheidungsautonomie aneignen, die sich im Einzelfall auch aktuellen Regeln widersetzen kann.

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“…For example, Germany physicians reported feeling increasing pressure to consider their hospitals’ economic interests when making clinical decisions. [52] Similarly, a recent analysis found most patients who received ECMO for Acute Respiratory Distress Syndrome (ARDS) – an unproven but profitable intervention for hospitals[53] – did not first have a trial of prone positioning which is considered a proven intervention for ARDS but is generally not billable. [54]…”

Section: Interests Of Hospitalsmentioning

confidence: 99%

Competing and conflicting interests in the care of critically ill patients

et al. 2018

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Medical professionals are expected to prioritize patient interests, and most patients trust physicians to act in their best interest. However, a single patient is never a physician's sole concern. The competing interests of other patients, clinicians, family members, hospital administrators, regulators, insurers, and trainees are omnipresent. While prioritizing patient interests is always a struggle, it is especially challenging and important in the ICU setting where most patients lack the ability to advocate for themselves or seek alternative sources of care. This review explores factors that increase the risk, or the perception, that an ICU physician will reason, recommend, or act in a way that is not in their patient's best interest and discusses steps that could help minimize the impact of these factors on patient care.

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The Commercialization of Patient-Related Decision Making in Hospitals

Cited by 41 publications

References 5 publications

Effects of Activity-Based Hospital Payments in Israel: A Qualitative Evaluation Focusing on the Perspectives of Hospital Managers and Physicians

Effects of Activity-Based Hospital Payments in Israel: A Qualitative Evaluation Focusing on the Perspectives of Hospital Managers and Physicians

Ethische Entscheidungen in zunehmend ökonomisierten Krankenhäusern

Competing and conflicting interests in the care of critically ill patients

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