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Chapter 11
Chapter 11

Financing & Delivery of Health Care

In today's health care, patient-physician relationships are influenced by changing payment systems and models for delivering care and thus physicians must find new ways to balance responsibilities to multiple stakeholders.

Access to health care

Physicians regularly confront the effects of lack of access to adequate care and have a corresponding responsibility to contribute their expertise to societal decisions about what health care services should be included in a minimum package of care for all. Physicians should advocate for fair, informed decision making about basic health care.
Opinion 11.1.1

Defining Basic Health Care

Because health care is a fundamental human good, society has an obligation to make access to an adequate level of care available to all its members, regardless of ability to pay.
Opinion 11.1.3

Allocating Limited Health Care Resources

Physicians have a responsibility to contribute their expertise to developing resource allocation policies that are fair and that safeguard the welfare of patients.
Opinion 11.1.4

Financial Barriers to Health Care Access

Physicians individually and collectively have an ethical responsibility to ensure that all persons have access to needed care regardless of their economic means.

Health care organizations & physician practices

Models for financing and organizing the delivery of health care services often aim to promote patient safety and to improve quality and efficiency. They can also pose ethical challenges for physicians that could undermine the trust essential to patient-physician relationships.
Opinion 11.2.1

Professionalism in Health Care Systems

Physicians should hold leaders accountable to meeting conditions for professionalism in health care systems. This includes advocating for changes in health care payment and delivery models to promote access to high quality care for all patients, recognizing that over-reliance on financial incentives may undermine physician professionalism.
Opinion 11.2.2

Conflicts of Interest in Patient Care

Under no circumstances may physicians place their own financial interests above the welfare of their patients. Treatment or hospitalization that is willfully excessive or inadequate constitutes unethical practice.
Opinion 11.2.3

Contracts to Deliver Health Care Services

Physicians have an ethical obligation to put the welfare of patients ahead of other considerations, including personal financial interests. This obligation requires them to consider carefully the terms and conditions of contracts to deliver health care services before entering into such contracts, to ensure that those contracts do not create untenable conflicts of interest.

Restrictive Covenants

Competition among physicians is ethically justifiable when it is based on such factors as quality of services, skill, experience, conveniences offered to patients, fees, or credit terms.
Opinion 11.2.4

Transparency in Health Care

Physicians have an obligation to inform patients about all appropriate treatment options, the risks and benefits of alternatives, and other information that may be pertinent, including the existence of payment models, financial incentives, formularies, guidelines, or other tools that influence treatment recommendations and care.
Opinion 11.2.5

Retainer Practices

Physicians are free to enter into retainer contracts to provide special non-medical services and amenities with individual patients who are willing and able to pay for them. However, physicians must always uphold their primary professional obligation of fidelity and their responsibility to treat all patients with courtesy, to respect patients’ rights and dignity, and to ensure that all patients in their practice receive the same quality of medical care.
Opinion 11.2.6

Mergers of Secular & Religiously Affiliated Health Care Institutions

Physicians within institutions that have or are contemplating a merger of secular and faith-based institutions have a responsibility to protect the community that the institution serves as well as the integrity of the institution, and other physicians and professionals who practice in association with it, while recognizing that physicians’ primary obligation is to their patients.
Opinion 11.2.7

Responsibilities to Promote Equitable Care

Health disparities across patient populations reflect deeply embedded, historically rooted socioeconomic and political dynamics. Physicians and health care institutions have a duty to serve as agents of change to address these structural barriers to optimal health for all.

Fees & charges

Physicians individually and collectively should promote access to care for individual patients, in part through being prudent stewards of resources. Thus physicians have a responsibility to balance patients’ needs and expectations with responsible business practices.
Opinion 11.3.1

Fees for Medical Services

Physicians should not recommend, provide, or charge for unnecessary medical services; nor should they make intentional misrepresentations to increase the level of payment they receive or to secure non-covered health benefits for their patients.
Opinion 11.3.2

Fees for Nonclinical & Administrative Services

Physicians have a responsibility to balance patients’ needs and expectations with responsible business practices. With respect to fees for nonclinical or administrative services provided in conjunction with patient care, physicians should clearly notify patients in advance of fees charged by the practice (if any) for nonclinical or administrative services and base fees (if any).
Opinion 11.3.3

Interest & Finance Charges

Financial obstacles to medical care can directly affect patients’ well-being and may diminish physicians’ ability to use their knowledge and skills on patients’ behalf. Physicians should not be expected to risk the viability of their practices or compromise quality of care by routinely providing care without compensation. Patients should make reasonable efforts to meet their financial responsibilities or to discuss financial hardships with their physicians.
Opinion 11.3.4

Fee Splitting

Payment by or to a physician or health care institution solely for referral of a patient is fee splitting and is unethical.