You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


Advertisement

ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | RSS | Access Rights | Sign In


  Vol. 151 No. 3, MARCH 1991 TABLE OF CONTENTS
  Online Only
 •  Online First Table of
Contents
  COMMENTARIES
 •Online Features
 This Article
 •References
 •Full text PDF
 • Reply to article
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on Web of Science (70)
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Delicious Add to Digg Add to Facebook Add to Reddit Add to Technorati Add to Twitter What's this?

Gaming the System

Dodging the Rules, Ruling the Dodgers

E. Haavi Morreim, PhD

Arch Intern Med. 1991;151(3):443-447.


Abstract



Although traditional obligations of fidelity require physicians to deliver quality care to their patients, including to utilize costly technologies, physicians are steadily losing their accustomed control over the necessary resources. The "economic agents" who own the medical and monetary resources of care now impose a wide array of rules and restrictions in order to contain their costs of operation. However, physicians can still control resources indirectly through "gaming the system," employing tactics such as "fudging" that exploit resource rules' ambiguity and flexibility to bypass the rules while ostensibly honoring them. Physicians may be especially inclined to game the system where resource rules seriously underserve patients' needs, where economic agents seem to be "gaming the patient," with needless obstacles to care, or where others, such as hospitals or even physicians themselves, may be denied needed reimbursements. Though tempting, gaming is morally and medically hazardous. It can harm patients and society, offend honesty, and violate basic principles of contractual and distributive justice. It is also, in fact, usually unnecessary in securing needed resources for patients. More fundamentally, we must reconsider what physicians owe their patients. They owe what is theirs to give: their competence, care and loyalty. In light of medicine's changing economics, two new duties emerge: economic advising, whereby physicians explicitly discuss the economic as well as medical aspects of each treatment option; and economic advocacy, whereby physicians intercede actively on their patients' behalf with the economic agents who control the resources.

(Arch Intern Med. 1991;151:443-447)



Author Affiliations



From the Department of Human Values and Ethics, College of Medicine, University of Tennessee, Memphis.


Footnotes



Accepted for publication August 13, 1990.

Reprints not available.



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Delicious Delicious   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Bioethics in a clinic for women with psychosis
Seeman and Seeman
J. Med. Ethics 2011;37:518-522.
ABSTRACT | FULL TEXT  

Geographic Variation in Diagnosis Frequency and Risk of Death Among Medicare Beneficiaries
Welch et al.
JAMA 2011;305:1113-1118.
ABSTRACT | FULL TEXT  

Interpretations of referral appropriateness by senior health managers in five PCT areas in England: a qualitative investigation
Blundell et al.
BMJQS 2010;19:182-186.
ABSTRACT | FULL TEXT  

Constrained Physical Therapist Practice: An Ethical Case Analysis of Recommending Discharge Placement From the Acute Care Setting
Nalette
ptjournal 2010;90:939-952.
ABSTRACT | FULL TEXT  

An anatomy of conflicts in primary care encounters: a multi-method study
Weingarten et al.
Fam Pract 2010;27:93-100.
ABSTRACT | FULL TEXT  

Professionalism in Pediatrics
Fallat et al.
Pediatrics 2007;120:e1123-e1133.
ABSTRACT | FULL TEXT  

Physicians' Interactions With Third-Party Payers: Is Deception Necessary?
Bogardus et al.
Arch Intern Med 2004;164:1841-1844.
ABSTRACT | FULL TEXT  

Assessing the Influence of Incentives on Physicians and Medical Groups
Town et al.
Med Care Res Rev 2004;61:80S-118S.
ABSTRACT  

Ethics in Practice: Managed Care and the Changing Health Care Environment: Medicine as a Profession Managed Care Ethics Working Group Statement
Povar et al.
ANN INTERN MED 2004;141:131-136.
ABSTRACT | FULL TEXT  

The Costs of Denying Scarcity
Alexander et al.
Arch Intern Med 2004;164:593-596.
FULL TEXT  

Support for Physician Deception of Insurance Companies among a Sample of Philadelphia Residents
Alexander et al.
ANN INTERN MED 2003;138:472-475.
ABSTRACT | FULL TEXT  

Coding of Pediatric Behavioral and Mental Disorders
Rushton et al.
Pediatrics 2002;110:e8-e8.
ABSTRACT | FULL TEXT  

Measuring Deception: Test-Retest Reliability of Physicians' Self-Reported Manipulation of Reimbursement Rules for Patients
VanGeest et al.
Med Care Res Rev 2002;59:184-196.
ABSTRACT  

The "Hassle Factor": What Motivates Physicians to Manipulate Reimbursement Rules?
Werner et al.
Arch Intern Med 2002;162:1134-1139.
ABSTRACT | FULL TEXT  

Deceiving insurance companies: new expression of an ancient tradition
Sade
Ann. Thorac. Surg. 2001;72:1449-1453.
FULL TEXT  

Should Physicians Manipulate Reimbursement Rules to Benefit Patients?
O'Neal et al.
JAMA 2000;284:1382-1383.
FULL TEXT  

Lying to Each Other: When Internal Medicine Residents Use Deception With Their Colleagues
Green et al.
Arch Intern Med 2000;160:2317-2323.
ABSTRACT | FULL TEXT  

Physician Manipulation of Reimbursement Rules for Patients: Between a Rock and a Hard Place
Wynia et al.
JAMA 2000;283:1858-1865.
ABSTRACT | FULL TEXT  

Physicians' Duties in an Era of Cost Containment: Advocacy or Betrayal?
Ubel
JAMA 1999;282:1675-1675.
FULL TEXT  

Should Doctors Ever Lie on Behalf of Patients?
Kinghorn
JAMA 1999;282:1674-1675.
FULL TEXT  

Lying for Patients: Physician Deception of Third-Party Payers
Freeman et al.
Arch Intern Med 1999;159:2263-2270.
ABSTRACT | FULL TEXT  

The Unbearable Rightness of Bedside Rationing: Physician Duties in a Climate of Cost Containment
Ubel and Arnold
Arch Intern Med 1995;155:1837-1842.
ABSTRACT  

Behind the Curve: A Critical Assessment of How Little is Known about Arrangements between Managed Care Plans and Physicians
Gold et al.
Med Care Res Rev 1995;52:307-341.
ABSTRACT  

Ethical Issues in Managed Care: Council on Ethical and Judicial Affairs, American Medical Association
Glasson et al.
JAMA 1995;273:330-335.
ABSTRACT  

Ethics
Pellegrino
JAMA 1994;271:1668-1670.
ABSTRACT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1991 American Medical Association. All Rights Reserved.