The Bander Essay Contest in Medical Business Ethics

The Bander Essay Contest is supported by the Saint Louis University Bander Center for Medical Business Ethics. The contest is meant to encourage scholarly inquiry into business ethics within the practice of medicine or the conduct of medical research.

Medical students, resident physicians, fellows, and physicians in practice are eligible to submit essays for consideration. Essays must be 2,000 words or fewer, typed, and double-spaced. The author’s name, address, telephone number, e-mail address, and affiliation (medical school and class, private practice site, hospital affiliation, etc.) should appear on the cover sheet only—not on the essay pages. Entries must be received as e-mail attachments by midnight CDT, December 15, 2009. Submit essays to Faith.Lagay@ama-assn.org.

A peer-review committee established by the Virtual Mentor editorial staff will select contest winners. Essays will be judged on understanding of the topic, applicability of the proposed policy to medical practice and patient care, clarity of writing and argumentation, and integration of relevant scholarly literature and data if appropriate.

The author of the best essay will be awarded $5,000. If more than one exceptional entry is received, up to three runner-up prizes of $1,000 each will be awarded. Winning essays will be published in Virtual Mentor.

2009 Contest Topic

The cost of medical care began to soar relative to other cost-of-living expenses after medical insurance became widespread. Insured patients did not pay directly for their own care, and physicians, assured of payment, had no financial reason to restrict diagnostic testing and treatment interventions.

During the 1990s, HMOs and other managed-care plans attempted to rein in the rising costs of medical care through a variety of means including paying physicians a set amount per patient per period or “capitated payment” independent of the utilization of medical services. However, cost-control methods like capitation and the use of primary physicians as “gatekeepers” were met with significant public dissatisfaction and backlash.

More recent attempts to control medical costs and ensure quality care include both rewards and penalties. Medicare is introducing pay-for-performance, which rewards the delivery of quality care based on clinical standards. At the same time, Medicare is also withholding payment to hospitals for so-called “never events,” defined as preventable complications, such as inpatient development of urinary tract infection related to catheter use.

Recognizing that various means for structuring payment incentives to physicians and hospitals—some reward-based and some penalty-based—can influence the type and amount of care patients receive and the ultimate cost of care, what elements do you think must be part of a payment system design that effectively balances the clinical judgment of physicians, ensures quality care for patients, and keeps cost under control?