Abstract
In this article Werhane explores the chaotic system of public and private health provision in the United States, and the complexity inherent in mixing managerial and medical priorities across a range of interlocking professional and commercial interests. Almost all health care professionals work in organizations, and these organizations are often managed by managerial specialists rather than health care specialists. Thus, the relationships between professional managers and health care professionals are constitutionally complex, not to mention frequently acrimonious. Such confrontations lead to moral stress. Unless they self-insure their patients, who then will have to interact personally with the insurers, health care organizations themselves have to interact with professional insurers as well as national and state Medicare and Medicaid programs, all of which operate with varying, complex and changing regulations. In addition, health care organizations interact with suppliers, non-health care workers and, most importantly, patients, some of whom may be uninsured. Bracketing these contextual arrangements tends to simplify the complex challenges of most health care providers, suppliers or insurers. A systems approach to the context helps individuals, patients, professionals, managers and organizations to imagine and think through these complexities to get a clearer picture of what is at stake. Moral imagination is, thus, useful as a tool in approaching these kinds of frequently problematic analyses.
Original publication: Werhane, Patricia H. “Business Ethics, Organization Ethics, and Systems Ethics for Health Care.” In The Blackwell Guide to Business Ethics, edited by Norman Bowie, 289–312. Boston: Blackwell’s, 2002. ©2002 Reprinted with permission.
Werhane, Patricia H. “Business Ethics, Organization Ethics, and Systems Ethics for Health Care.” In The Blackwell Guide to Business Ethics, edited by Norman Bowie, 289–312. Boston: Blackwell’s, 2002. ©2002 Reprinted with permission.
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Notes
- 1.
Reprinted by permission from the Hasting Center Report, Special Supplement, 1998: What Could Have Saved John Worthy? July–August. S1–Sl2.
- 2.
The long-term financial performance of each has been remarkable. A dollar invested in a visionary company stock fund on 1 January 1926, with dividends reinvested, and making appropriate adjustments for when the companies became available on the stock market would have grown by 31 December 1990 to $6356. A dollar invested in a comparison stock fund composed of these companies would have returned $955 – more than twice the general market, but less than one sixth of the return provided by the visionary companies. That dollar invested in a general market fund would have grown to $415 (Collins and Porras, 1994, pp. 4–5).
- 3.
See Jones et al., [(2002). …]
- 4.
Ozar et al. (2001) postulate other priorities inducing unmet healthcare needs, advocacy for social policy reform and community benefit. I have gathered those together in the community and public health category. Ozar et al. also place organizational solvency and survival in the list of secondary priorities. I disagree with this prioritization.
- 5.
In analyzing the ethics of systems, Linda Emanuel proposes an evaluative grid that sets out the purpose, structure, processes and outcomes of a particular system against professional, political, and economic models (Emanuel, 2000, Table 1, p. 161). While the details of that grid are certainly subject to more debate, this approach pushes us into the direction of more broad-based systems thinking and into more creative and imaginative ways to analyze and evaluate healthcare systems. In the case of Worthy, we are working on a more micro level, dealing with issues within the US healthcare system and the system of GoodCare. Moreover, using Emanuel’s grid, one has to sort out and evaluate professional, political, and economic models as they apply to health care. Our prioritization in the previous section of patient health and autonomy, professional competence and excellence, economic viability, and public health is one example of such an evaluative scheme. While many will argue as to the sequencing of these priorities, some sort of prioritization is implicit in any list of professional, political and economic norms, and making those explicit helps to clarify where there is congruence.
- 6.
A physician writing about confidentiality of patient information did an informal survey and found that 75 clinicians or employees had legitimate access to his patient’s record, which meant that they were in some measure engaged in his patient’s care (Mark Siegler, 1982).
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Further Reading
Berwick, D. M. and Nolan, T. W, 1998: Physicians as leaders in improving health care. Annals of Internal Medicine. 128, 289–92.
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Werhane, P.H. (2019). Business Ethics, Organization Ethics, and Systems Ethics for Health Care. In: Bevan, D.J., Wolfe, R.W., Werhane, P.H. (eds) Systems Thinking and Moral Imagination. Issues in Business Ethics(), vol 48. Springer, Cham. https://doi.org/10.1007/978-3-319-89797-4_12
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