The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #57597

Martin T Donohoe, MD, FACP, Senior Scholar, Center for Ethics in Health Care, Oregon Health and Science University, 3718 Rivers Edge Drive, Lake Oswego, OR 97034, 503/819-6979, martin.donohoe@verizon.net

Medical schools and teaching hospitals have been hit particularly hard by the financial crisis affecting health care in the United States. To compete financially, many academic medical centers have recruited wealthy foreign patients and established luxury primary care clinics. At these clinics, patients are offered tests supported by little evidence of their clinical- and/or cost-effectiveness, which erodes the scientific underpinnings of medical practice. Given widespread disparities in health, wealth and access to care, as well as growing cynicism and dissatisfaction with medicine among trainees, the promotion by these institutions of an overt, two-tiered system of care which exacerbates inequities and injustice erodes professional ethics. Academic medical centers should divert their intellectual and financial resources away from luxury primary care and towards more equitable and just programs designed to promote individual, community and global health. The public and its legislators should in turn provide adequate funds to facilitate this. Ways for academic medicine to facilitate this largesse are discussed.

Learning Objectives:

At the conclusion of the session, participants will be able to:
• Explain the nature of the financial crisis affecting medical schools and teaching hospitals in the United States.
• Describe the extent and nature of luxury primary care clinics (aka "executive health clinics") affiliated with academic medical centers in the United States.
• Discuss the ways in which these clinics utilize non-evidence-based, cost-ineffective medicine, which undermines the scientific underpinnings of modern health care.
• Articulate how these clinics, established in the midst of hospitals' decreasing commitments to the un- and underinsured, exacerbate inequalities in health care between rich and poor and engender cynicism among practicing physicians and students/trainees.
• Identify ways in which health care practitioners and the public can encourage society to support more equitable programs, designed to promote individual, community and global health, at academic medical centers.

Keywords: Access to Health Care, Ethics

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.