Conflicts of Interest and the Future of Medicine: The United States, France, and Japan

Conflicts of Interest and the Future of Medicine: The United States, France, and Japan

Conflicts of Interest and the Future of Medicine: The United States, France, and Japan

Conflicts of Interest and the Future of Medicine: The United States, France, and Japan

Synopsis

Health care reform has dominated America's domestic politics in the past year, and will remain one of the most important policy issues for the foreseeable future. While 'reform' covers many important issues--e.g., expanding coverage and improving primary care--controlling costs has taken center stage. Extravagant payments for non-essential care pervade the American system, driving up overall costs and making health care a far larger component of the economy than it is in other advanced democracies.

As Marc A. Rodwin explains in Conflicts of Interest and the Future of Medicine, conflicts of interest are a root of the problem. The ideal doctor-patient relationship is one in which physicians provide appropriate and timely treatment--not too much, and not too little--to patients. Modifying this relationship because of either the prospect of financial gain or the need to maintain the medical profession's dominance over the field vis- -vis other players (insurers, hospitals, or the state) is a conflict of interest. As virtually all Americans know, conflicts of interest riddle the U.S. health care system. HMOs rationing care, doctors accepting kickbacks from pharmaceutical companies, and physicians who undertake too many procedures are all too common in the US, and are largely the product of our market-dominated system.

Yet widespread conflicts of interest are not unique to the US. In fact, they exist in different form in virtually all advanced nations. Rodwin offers a systematic comparison of the medical economies in the US, France, and Japan, tracing the centuries-long evolution of their respective medical systems. In each country, conflicts of interest are a problem, but in different ways. In France, the state controls most hospitals, but doctors' organizations have effectively prevented state oversight of how doctors can practice-and how they can prescribe. In Japan, investors cannot own hospitals and clinics. Doctors own them and run them as nonprofit entities. Yet doctors focus their energies on protecting private practitioners from oversight. Doctors can dispense drugs themselves, which means that they are particularly susceptible to kickbacks from drug companies.

In the course of analyzing these three nations, Rodwin considers the prospects for reform today. He closes with a series of recommendations for reform, and addresses the passsage of the health care reform bill in the US.
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