Medical law and Ethics

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Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Medical Law and Ethics

Today’s Healthcare

Environment

Chapter 4

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Today’s Health Care Environment

• Major changes since 1965 with Medicare and Medicaid – Increased life expectancy = more older adults

– Technological discoveries

• Preventative care and patient education stressed (but not funded)

• Government legislation

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Today’s Health Care Environment

• Fixed-payment plans—medical care for a fixed monthly fee

• Third-party payers

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Managed Care Organization (MCO)

• Gatekeeper • Health Maintenance Organization (HMO

– offers a wide range of services to members for a

predetermined fee by a limited group of providers

• Preferred Provider Organization (PPO – patient must use a medical provider who is under

contract with the insurer for an agreed-upon fee

• Exclusive Provider Organization (EPO) – combines the concepts of HMO and PPO

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Federal Assistance Programs

• Medicare – Health care coverage for elderly or seriously

disabled or with end stage renal disease or

other debilitating ailments regardless of

wealth or income

– Rationing of health care

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Medicaid

• Medicaid: A joint Federal–State program • Federal program implemented by

individual states

• Financial assistance to insure poor and indigent

• Rationing takes place • Not all providers accept Medicaid

coverage

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Diagnostic Related Groups (DRGs)

• Classifies Medicare patient by illness • 467 illness categories • Hospitals receive preset sum for

treatment of category regardless of “bed

days” used

• Discourages treatment of severely ill patients; patients often are discharged

before ready

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Ethical Considerations of Managed Care

• Wealthy may have greater access to care and treatment than poor patients

• Must provide minimum standard of care to everyone

• Patients must be fully informed of consequences of obtaining health care elsewhere

• Bait-and-switch • Profit may be more important than patient

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Types of Medical Practice

• Solo practice • Sole proprietorship • Partnership • Associate practice • Group practice • Professional corporation

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Ethics of Fee Splitting

• Fee splitting: one physician offers to pay another for referral (unethical and illegal)

• Fee splitting vs. referrals • Franchise: business run by individual to

whom franchisor grants exclusive right to market product or service in certain market area (ethical)

• Franchisees: persons or companies that hold a franchise

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Medical Specialty Boards

• Over 23 specialty boards • Seek to improve quality of medical care • Encourage physicians to further

education and training

• Evaluate candidates who apply and pass exam

• Board-certify those who pass

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

• American College of Surgeons – Fellow of American College of Surgeons

(FACS)

• American College of Physicians – Fellow of American College of Physicians

(FACP)

Medical Specialty Boards

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Allied Health Professionals

• Licensed personnel include: – Registered nurse

– Nurse practitioner

– Licensed practical nurse

– Pharmacist

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Allied Health Professionals

• Certified personnel include: – Physician assistant

– Medical assistant

– Medical transcriptionist

– Lab technician

– Lab technologist

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Conscience Clause

• Enacted by several states • Employees may have a moral or religious

objection to assisting with certain

procedures (sterilization, abortion)

• Employee cannot be discriminated against under the state’s statute