The Theory and Practice of Disclosing HMO Physician Incentives

Despite the widespread consensus that physician incentives under managed care should be disclosed, there is little agreement on the who, what, when, and how of disclosure, nor is there agreement on the primary purpose of disclosure. Three forms of market failure point to three distinct, but overlapping purposes of disclosure, each of which points toward different forms, sources and contents of disclosures

Dissecting Medical Referral Mechanisms in Health Services: Role of Physician Professional Networks

Medical referrals between primary care physicians (PC) and specialist care (SC) physicians profoundly impact patient care regarding quality, satisfaction, and cost. This paper investigates the influence of professional networks among medical doctors on referring patients from PC to SC. Using five-year consultation data from a Portuguese private health provider, we conducted exploratory data analysis and constructed both professional and referral networks among physicians. We then apply Graph Neural Network (GNN) models to learn latent representations of the referral network. Our analysis supports the hypothesis that doctors' professional social connections can predict medical referrals, potentially enhancing collaboration within organizations and improving healthcare services. This research contributes to dissecting the underlying mechanisms in primary-specialty referrals, thereby providing valuable insights for enhancing patient care and effective healthcare management.Comment: 27 pages, 9 figures, 2 table

The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India

A heterogeneous private sector dominates healthcare provision in many middle-income countries. In India the contemporary period has seen this sector undergo corporatisation processes characterised by emergence of large private hospitals and the takeover of medium-sized and charitable hospitals by corporate entities. Little is known about the operations of these private providers and the effects on healthcare professions as employment shifts from practitioner-owned small and medium hospitals to larger corporate settings. This article uses data from a mixed-methods study in two large cities in Maharashtra, India, to consider the implications of these contemporary changes for the medical profession. Data were collected from semi-structured interviews with 43 respondents who have detailed knowledge of healthcare in Maharashtra, and from a witness seminar on the topic of transformation in Maharashtra’s healthcare system. Transcripts from the interviews and witness seminar were analysed thematically through a combination of deductive and inductive approaches. Our findings point to a restructuring of medical practice in Maharashtra as training shifts towards private education and employment to those corporate hospitals. The latter is fuelled by substantial personal indebtedness, dwindling appeal of government employment, reduced opportunities to work in smaller private facilities, and the perceived benefits of work in larger providers. We describe a ‘re-professionalisation’ of medicine encompassing changes in employment relations, performance targets and constraints placed on professional autonomy within the private healthcare sector, that is accompanied by trends in cost inflation, medical malpractice, and distrust in doctor-patient relationships. The accompanying ‘re-stratification’ within this part of the profession affords prestige and influence to ‘star doctors’ while eroding the status and opportunity for young and early career doctors. The research raises important questions about the role that government and medical professionals’ bodies can, and should, play in contemporary transformation of private healthcare, and the implications of these trends for health systems more broadly

Against Fiduciary Utopianism: The Regulation of Physician Conflicts of Interest and Standards of Care

This Article critically examines calls by scholars, legislators, and regulators advocating the imposition of fiduciary duties upon a broad range of actors including judges, jurors, agencies, parents, friends, and even entire countries. The Article examines the physician-patient relationship—an archetypal and frequently cited relationship in which fiduciary duties, administered by courts, are asserted to work well. It argues that some of the most significant problems fiduciary duties are used to address like asymmetry of information, conflicts of interest, and professional conduct have not only been handled badly by courts, but have actually found more effective resolution through legislative fact-finding, acknowledgment of the complexity of medical practice, and ultimately regulatory solutions aimed at sources of conflicts of interest and specific circumstances in which claims for medical malpractice arise. Behind many of these initiatives are physicians themselves—who experience the sources of potential conflicts and endeavor to create self-regulatory and legislative solutions to them. In contrast, court-administered fiduciary duties are often marginalized as judicially manageable claims related to the duties of loyalty and the duty of care converge, litigants focus on settlement, and the high expectations held for fiduciaries are rarely enforced. The Article concludes that not only may imposing more fiduciary duties on more relationships not generate the benefits many scholars suggest, but that doing so will stymie more targeted and effective solutions to problems that occur in trust relationships