AMA journal of ethics最新文献

This article investigates the importance of storytelling for human well-being. Special attention is given to the roles storytelling has played in human evolution, how sharing stories informs embodied experiences, and the role of storytelling within medicine to promote health.

Private equity (PE) investments in health care have grown to over $750 billion in the past decade and include every segment of the US health sector. Although PE investments can provide capital and improve efficiency of health service delivery, PE's emphasis on short-term profitability could raise costs, diminish quality of care, and negatively influence clinician autonomy and career satisfaction. This article first canvasses what is currently known about how PE investments in physician practices influence clinician practice patterns and then proposes regulatory and legislative strategies for restricting harms of PE ownership of clinician practices and for fostering affordable and high-value health services.

Private equity (PE) firms' acquisition and management of health service delivery entities, such as specialty physicians' practices, have been associated with increased cost and diminished quality of care. This commentary on a case argues that clinician-sellers have obligations to disclose to their patients known and foreseeable changes-especially those affecting services' cost or quality or health outcomes-to which PE ownership could contribute.

Private equity firms exacerbate health inequity by driving hospital closures in historically underserved communities. Now nonprofit health systems seem to be adopting private equity practices to do the same. Drawing on a case study of one nonprofit hospital system that has adopted private equity business practices to acquire and close community hospitals, this article argues that nonprofit hospitals' adoption of private equity acquisition and closure practices sacrifices their missions, prioritizes profit, and works to the detriment of local communities. This article construes this set of practices as a breach of organizational ethics that must be addressed via policy changes, specifically by placing guardrails on closures and promoting responsible health care investments.

One driver of the corporatization of medicine has been private equity (PE) firms' acquisition of physician practices. This article describes when PE firms' investments in or ownership of physicians' practices undermine health service delivery operations and patients' outcomes to the point of violating primum non nocere, a key ethical requirement for physicians to prioritize harm avoidance in practice. This article then suggests how to balance the interests of health care as a commercial enterprise with health care as a critical human right.

Private equity investments in health care raise several clinical and ethical questions about private equity's influence on clinicians' practices. This article canvasses how these questions are navigated in AMA Code of Ethics opinions.

Private equity (PE) margin maximization and profit-making strategies focus on acquisition, short-term ownership, and sale of health care entities, including residency program opportunities. PE ownership durations generally have 3 purposes: reduce staff, sell assets, and refinance debt. The purpose of graduate medical education (GME), however, is to provide learning and training opportunities in a variety of clinical, academic, technical, and research domains. This article offers examples of PE involvement in residency training and argues that PE and GME purposes not only conflict but add instability to graduate medical education learning environments. This article also suggests reasons why PE investment in GME, including residency "slot" ownership, undermines academic health centers' ethical and educational obligations to trainees in their GME programs.

This article explains how some investment practices of private equity (PE) firms generate profit by taking advantage of inequitably underserved patients in the US health care system. In particular, patients with general medical or mental health needs who seek care at safety-net hospitals or in carceral facilities and patients seeking mental health services are vulnerable to the following PE strategies: purchasing low-quality practices where patients lack opportunities to get care elsewhere, maximizing consolidation of deeply fragmented health service delivery systems, and avoiding accountability for poor-quality service that results from regulatory opacity. For each problem area, the article offers a policy response to mitigate harm to patients.

One driver of the corporatization of medicine has been private equity (PE) firms' acquisition of physician practices. This article describes when PE firms' investments in or ownership of physicians' practices undermine health service delivery operations and patients' outcomes to the point of violating primum non nocere, a key ethical requirement for physicians to prioritize harm avoidance in practice. This article then suggests how to balance the interests of health care as a commercial enterprise with health care as a critical human right.

Capital and staff shortages have forced many rural hospitals to close. Private equity investment in rural hospitals has been one solution to these problems. This article argues, however, that private equity firms' business practices, especially shortening acquisition-to-sale time and maximizing profit margin, generate overall health care market instability. This consequence can be particularly devastating for people living in rural areas of the United States, who report worse health outcomes, more chronic disease, and more restricted access to health services than people in urban or suburban regions.