The Corporate Practice of Medicine and Long-Term Health Status: Future Research Issues

Article excerpt

Are the profit needs of corporate America and long-term health status of individuals and society inconsistent? This work represents a conceptual exploration of the general proposition that decisions made in a corporate environment are more likely to be made in the interest of profitability and Wall Street performance rather than individual health status. In this theoretical examination, the term corporate practice of medicine refers to any provision of healthcare services for a profit. The general focus of the work is on corporate behavior associated with decision-making in healthcare corporations. The term also includes competitive managed care entities like Health Maintenance Organizations (HMOs), Point of Service Plans (POS), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), and Individual Practice Associations (IPAs).

The point of this line of inquiry is to obtain more insight on possible societal issues related to a competitive environment in which healthcare is traded like any other marketable service. For example, one reality with which healthcare policy stakeholders are becoming increasingly familiar, and with which consumers of healthcare services are becoming increasingly wary, is that in a competitive, managed-care environment corporate healthcare providers are rewarded for providing less care rather than more care. That is, financial incentives to over-treat patients have been replaced by financial incentives to under-treat patients.(1)

This paper focuses on a review of journal-based literature to bring insight into preliminary research questions. Three working research questions were fashioned to encourage examination of a broad literature base sensitive to the central focus on corporate, for-profit provider behavior and long-term health status. The purpose of this approach is to facilitate the future efforts by others interested in pursing this research area. The initial working research questions that emerge from this inquiry approach include: (1) what are examples of physician-patient relationship issues related to the corporate practice of medicine that might be inconsistent with long-term health status? Selective literature responsive to this question appears to share the common theme of Physician-Patient Relationship Issues; (2) what are examples of ways that managed care plans restrict access to healthcare services that impact long-term health status? Literature in this area is framed by the concept of Ways to Restrict Access; (3) what are examples of current methodologies and systems used to evaluate health status outcomes? Ways to Measure Health Status seems to capture the thrust of the essentially technical literature responsive to this question. In this regard, the current measurement literature appears to focus most on identification of current health status measures appropriate for providers beginning to assess the impact of their services on health status.

Based on the review of the literature, this work concludes with specific research questions in each of these areas. Readers will hopefully recognize that the nature of the task of organizing separate streams of literature may limit the extent to which each stream may appear to be related to the other. Thus, while sections one and two, concerning the first two organizing questions appear to be related, the third question on measurement issues, while nonetheless critical to the purpose of the paper, may appear to be less related to the flow of the paper in the first two areas.

BACKGROUND

The passage of the Health Maintenance Organization Act of 1973 signaled the transformation of the American healthcare delivery process. The development of the corporate, for-profit, managed care model since 1973 has focused primarily on market growth and cost control. Few societal protection mechanisms have accompanied the corporate model to serve as standards of profit-making reasonableness. …