Contents

• Preface
• An Introduction to the New Health Care for Profit
  • The Changing Health Care Environment
  • Professional Autonomy, Trust, and Health Policy
  • Implications of the Current Changes in For-Profit Health Care
  • The Institute of Medicine Project
  • Conclusion
  • References and Notes
• Legal Differences Between Investor-Owned and Nonprofit Health Care Institutions
  • Organizational Differences
  • Financial Differences
  • Other Legal Differences
  • Conclusion
  • References and Notes
• Wall Street and the For-Profit Hospital Management Companies
  • Analysts' Sources of Information
  • Financial Analyses of Companies
  • The Importance of Stock Prices To the Companies
  • Reasons For Success of the Hospital Management Companies
  • Differences Among Companies
  • Acquisitions
  • Making Hospitals Healthier
  • Outlook For the Future
  • References and Notes
• When Investor-Owned Corporations Buy Hospitals: Some Issues and Concerns
  • The Five Cases
  • Major Issues
  • The Process
  • Conclusions
  • Appendix Principal Interviews Conducted for This Paper
• Physician Involvement in Hospital Decision Making
  • A Typology of Hospital Decision Making
  • Convergence versus Divergence of Interests
  • The Decision Makers
  • Strain Among Decision Makers and Between the Two Models
  • Types of Physician Decision-Making Involvement
  • Hospital/Physician Decision Making and the Cost and Quality of Care
  • Future Issues
  • Summary
  • References and Notes
• Economic Incentives and Clinical Decisions
  • Models of Clinical Decision Making
  • Incentives from the Perspective of the Physician and the Economist
  • Summary and Conclusions
  • References
• Ethical Dilemmas of For-Profit Enterprise in Health Care
  • History of the Ethics Controversy
  • A Summary of the Professional Physician Stance
  • Physicians Compared with Other Professionals
  • A Philosophical Evaluation of the Problem
  • Conclusion
  • References and Notes
• Secondary Income From Recommended Treatment: Should Fiduciary Principles Constrain Physician Behavior?
  • The Physician-Patient Conflict of Interest Problem
  • Background of Fiduciary Law
  • Fiduciary Theory in Medical Litigation
  • Conclusion
  • References and Notes
• Biographical Sketches of Contributors

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.