The Bottom Line: Profit Motive in American Medicine

Unlike countries with nationalized or highly regulated health care systems, the US has a market-based capitalist system. The August 2015 issue of the AMA Journal of Ethics examines a quintessentially American medical ethics topic: how market forces, including the profit motives of corporate interests, shape the delivery of and payment for medical services. The market orientation of the US system influences medical education and physicians’ relationships with drug and device manufacturers; it affects the availability of drugs, patients’ ability to access and afford care, the type of treatment they are prescribed, and what happens when they can’t pay their hospital bills.

Volume 17, Number 8: 715-814 Full Issue PDF
  • From the Editor
    Aug 2015

    Medicine and the Market

    Hannah L. Kushnick, MA
    In taking for granted that the US health care system is market based, we sometimes overlook the ethics problems created by the profit motive in medicine.
    AMA J Ethics. 2015;17(8):727-728. doi: 10.1001/journalofethics.2015.17.8.fred1-1508.
  • Case and Commentary
    Aug 2015

    Assessing Information from Pharmaceutical Company Representatives

    Shahram Ahmadi Nasab Emran, MD, MA
    Physicians should not only avoid forming personal relationships with drug reps but must also acquire and apply numeracy skills and information management strategies to critically evaluating drug reps’ information.
    AMA J Ethics. 2015;17(8):729-733. doi: 10.1001/journalofethics.2015.17.8.ecas1-1508.
  • Case and Commentary
    Aug 2015

    Donations of Expensive Equipment for Resident Training

    Ashvini K. Reddy, MD
    Because the choice of surgical equipment has long-term consequences for patients and trainees, physicians who are deciding whether to accept donations of it should consider whether the donated equipment is what they would buy if they had the money to buy the best.
    AMA J Ethics. 2015;17(8):734-738. doi: 10.1001/journalofethics.2015.17.8.ecas2-1508.
  • Medical Education
    Aug 2015

    Teaching Medical Business Ethics: An Introduction to the Bander Center’s Casebook

    Erin L. Bakanas, MD and Tyler A. Zahrli
    The casebook developed by the Bander Center for Medical Business Ethics provides a comprehensive instrument for teaching medical business ethics decision making by exploring the effects of relevant variables on medical practice and research and reflecting on the values and motives that influence the behavior of health care professionals.
    AMA J Ethics. 2015;17(8):744-749. doi: 10.1001/journalofethics.2015.17.8.medu1-1508.
  • In the Literature
    Aug 2015

    Pricing Cancer Drugs: When Does Pricing Become Profiteering?

    Hannah L. Kushnick, MA
    The high price of cancer drugs in the US relative to European countries with universal health care raises ethical issues of access, financial burden on patients, and unsustainability of the health care system.
    AMA J Ethics. 2015;17(8):750-753. doi: 10.1001/journalofethics.2015.17.8.nlit1-1508.
  • Health Law
    Aug 2015

    The Affordable Care Act and Insurer Business Practices

    Sandy H. Ahn, JD, LLM
    The ACA’s major changes to health insurers’ practices, which include requirements for adequate and affordable health insurance coverage, have resulted in a substantial reduction in the number of uninsured people in the US.
    AMA J Ethics. 2015;17(8):754-759. doi: 10.1001/journalofethics.2015.17.8.hlaw1-1508.
  • Health Law
    Aug 2015

    IRS Rules Will Not Stop Unfair Hospital Billing and Collection Practices

    Erin C. Fuse Brown, JD, MPH
    New Internal Revenue Service rules that ostensibly limit harsh hospital billing practices provide inadequate protection for many patients by excluding for-profit hospitals and allowing hospitals to determine eligibility for financial assistance.
    AMA J Ethics. 2015;17(8):763-769. doi: 10.1001/journalofethics.2015.17.8.hlaw3-1508.
  • AMA Code Says
    Aug 2015

    AMA Code of Medical Ethics’ Opinions on Physicians’ Financial Interests

    AMA Council on Ethical and Judicial Affairs
    The American Medical Association Code of Medical Ethics’ opinions on physicians’ self-referral and physicians’ sale of health-related and non-health-related products from their offices.
    AMA J Ethics. 2015;17(8):739-743. doi: 10.1001/journalofethics.2015.17.8.coet1-1508.
  • Policy Forum
    Aug 2015

    The All-Payer Rate Setting Model for Pricing Medical Services and Drugs

    Gerard Anderson, PhD and Bradley Herring, PhD
    The all-payer rate setting model of pricing combines a uniform payment method with a single rate that all private and public insurers pay for a specific service, thus improving price transparency for patients.
    AMA J Ethics. 2015;17(8):770-775. doi: 10.1001/journalofethics.2015.17.8.pfor1-1508.
  • Policy Forum
    Aug 2015

    Policymaking for Orphan Drugs and Its Challenges

    Taeho Greg Rhee, AM
    The Orphan Drug Act of 1983 provides incentives to encourage the development of drugs for rare diseases, but available orphan drugs tend to be expensive and targeted to the more common of the rare diseases.
    AMA J Ethics. 2015;17(8):776-779. doi: 10.1001/journalofethics.2015.17.8.pfor2-1508.
  • Medicine and Society
    Aug 2015

    Money and Medicine: Indivisible and Irreconcilable

    Eli Y. Adashi, MD, MS
    Medicine is a service industry, the product of which is health care, and its practitioners deserve remuneration. But to some, the notion of medicine as a road to personal wealth is an example of free-market economics gone awry.
    AMA J Ethics. 2015;17(8):780-786. doi: 10.1001/journalofethics.2015.17.8.msoc1-1508.
  • Medicine and Society
    Aug 2015

    Medicine’s Valuing of “Normal” Cognitive Ability

    Julie M.G. Rogers, PhD, C. Christopher Hook, MD, and Rachel D. Havyer, MD
    The medical profession’s valuing of intellectual ability may inadvertently harm people with intellectual or cognitive disabilities who have a different notion of “the good life.”
    AMA J Ethics. 2015;17(8):717-726. doi: 10.1001/journalofethics.2015.17.8.peer1-1508.
  • Viewpoint
    Aug 2015

    Mixing Dinner and Drugs: Is It Ethically Contraindicated?

    David F. Essi, MA
    Despite industry regulations for pharmaceutical speaker programming at restaurants, pharmaceutical representatives, compliance companies, and restaurants lack incentives for ensuring compliance with guidelines.
    AMA J Ethics. 2015;17(8):787-795. doi: 10.1001/journalofethics.2015.17.8.sect1-1508.