Abstract
In response to a competitive environment, hospital administrators are pressuring physicians to discharge Medicare patients “sicker and quicker” and to transfer indigent patients from their emergency rooms. This paper compares health administrators' ethics to public expectations regarding financially motivated hospital transfers and discharges. Health administrators use balancing strategies: code morality, survivalism, mission dependency, and tithing. Public expectations, exemplified in P.L. 99–272, P.L. 99–509, and recent case law, are based on norms of potential for patient harm and patient occupancy. These norms are morally preferable to those of health administrators; they reinforce the value of identified lives and the reliability of the health care system.
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The author wishes to thank Dr. James F. Childress and the participants in the 1986 NEH summer seminar, “Principles and Metaphors in Biomedical Ethics,” for their helpful comments on an earlier draft of this work.
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Spielman, B.J. Financially motivated transfers and discharges: Administrators' ethics and public expectations. J Med Hum 9, 32–43 (1988). https://doi.org/10.1007/BF01115241
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DOI: https://doi.org/10.1007/BF01115241