For-Profit Enterprise in Health Care (1986) / Chapter Skim
Currently Skimming:
7 Implications for Education and Research
7 Implications for Education and Research
Pages 142-150
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From page 142... ...
Until recently, investor-owned companies showed little interest in acquiring teaching hospitals, and not-for-profit and public teaching hospitals had lithe reason to consider a change of ownership. American Hospital Association data show that as recently as 1983 (see Table 7.1)
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At this juncture it is possible only to describe how investor-owned firms are becoming involved in education and research and to suggest some reasons for this involvement, to speculate about fixture developments, and to raise potential areas of discuss that should be monitored. TEACHING HOSPITALS AND INVESTOR-OWNED HOSPITAL COMPANIES Because of their size, multiple Unctions, diverse sources of Finding, and relationships with other institutions, major teaching hospitals are exceedingly complex institutions.
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From page 144... ...
programs and for the clinical component of undergraduate education in medicine, nursing, pharmacy, and the aLied health professions. Although most support for health professional education comes through health professional schools, hospital fiends have been an important source of support for graduate medical education by providing space for instruction, by paying the salaries of residents and directors of graduate medical education programs, and, in some cases, by paying medical faculty to supervise and teach residents.
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From page 145... ...
In particular, medical school faculties, who serve as the medical staff of these hospitals, have viewed such changes in ownership or management as threats to traditional values, missions, operating procedures; and power relationships within He hospital and between it and other components of academic health centers. More specifically, faculty physicians have been concerned that in the interests of satisfying their investors, these companies sooner or later will institute changes to · reduce faculty control over unclergraduate and graduate medical education TABLE 7.3 Motivations for Negotiations Between Investor-Owned Health Care Companies and Teaching Hospitals Motives for Teaching Hospitals and Their Parent Institutions Motives for Investor-Owned Companies To obtain the capital needed for future renovation, acquisition of equipment, etc., without adding to hospital cost base To gain greater cost-effectiveness from advantages in management, scale, and bottom-line discipline and freedom from civil service or university personnel, procurement, and contracting systems To gain access to new sources of revenues through referral networks, marketing skills, and emphasis on patient care To reduce some governance problems, and reduce diffusion of the decision-making process To respond to criticism that they have avoided their social responsibility by not supporting education and research To achieve greater legitimacy, prestige, and visibility To achieve profits from individual teaching institutions or from regional networks of hospitals and other health care providers that include these hospitals To gain access to the capability for technology assessment and other research activities To provide expert consultations for physicians at company-owned nontertiary care institutions To gain access to a pool of physician trainees for possible fixture recruitment
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From page 146... ...
that motivate the hospital to explore relationships with for-profit organizations. It can be argued, for example, that it is valuable to expose the health professional in training for health care delivery in an environment where concern for the bottom line perhaps weighs more heaviTy than in traditional settings; to provide experience with the type of large-scare organizations that some observers see as constituting the future of health care; or, perhaps, to increase student access to community hospitals, nursing homes, and freestanding ambulatory care centers that companies own.
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From page 147... ...
By 1983, income Tom medical service represented Dom onefourth to one-half of medical school revenues (Petersdorf, 1985~. This means a considerable shift in emphasis from teaching and research toward practice.
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Although most biomedical research studies receive outside support (from the National Institutes of Health, the pharmaceutical industry, or other sources) , some unsponsored research is conducted at many institutions.
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From page 149... ...
Perhaps because of the danger that Humana's investment in the artificial heart might conflict with its responsibilities to patients in its hospitals, Humana reported in its 1984 Annual Report that it is selling its Symbion stock, although Humana's executives continue to own stock, and one sits on the Symbion board. Similar issues would have arisen had the proposed merger taken place between lICA and the American Hospital Supply Company, the manufacturer of many devices used in patient care (e.g., artificial valves for hearts)
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From page 150... ...
S hospitals have affiliations win medical schools (American Hospital Association, 1984~; 424 hospitals were members ofthe Council of Teaching Hospitals (COTH)
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