Q&A: ACP calls on health systems to prioritize patients over profit

An increasing trend in for-profit entities and private equity investments in medicine could lead to a fragmented health care system, according to a position paper by the ACP.

“The steady growth of corporate interest and influence in the health care sector over the past few decades has created a more business-oriented health care system in the United States,” Ryan Crowley, BSJ, senior associate for health policy at ACP, and colleagues wrote.

The authors noted that proponents of this trend believe it encourages innovation and offers financial stability to improve care, while critics argue that it erodes the patient-physician relationship.

Crowley and colleagues called for more research to investigate the potential effects of financial profits on patients, physicians and the health care system. They also advocated for a physician’s right to make a reasonable income “as long as they are fulfilling their fiduciary responsibility to provide high-quality care that is appropriate and ethical.”

In addition to conducting more research on financial profit in medicine, the paper outlines other recommendations that the health care system should follow to protect a patients-over-profit orientation, including:

• taking action to support the patient-physician relationship, such as ensuring all Americans have access to health care coverage, aligning payment and delivery system reform incentives with patient interest, expanding evidence-based, patient-centered, shared decision-making tools, and ensuring price and quality are transparent;
• requiring non-profit hospitals to provide measurable benefits to the community in exchange for non-profit status;
• requiring Medicare-participating hospitals, regardless of tax-exempt status, to adopt uniform fair pricing, billing and collection policies;
• making sure public authorities scrutinize mergers, acquisitions and buy-outs that involve health care entities; and
• ensuring state government officials oversee insurer conversions.

Healio Primary Care spoke with Crowley to learn more about the ACP’s stance on profit motive in the U.S. health care system.

Healio Primary Care: Can you briefly describe the driving factors that led the ACP to publish this policy paper and related recommendations?

Crowley: The U.S. health care system has become more profit oriented and corporatized over the past few decades. We spend more than other high-income peer nations on health care, but we don’t always have better outcomes. Has more private investment in the health care industry led to more efficiency and innovation to address this problem, or has it led to higher costs to appease shareholders? More importantly, what is the effect on the patient-physician relationship, health equity and quality care? It’s a really complex topic, and ACP’s Health and Public Policy Committee wanted to get a better understanding of it.

Healio Primary Care: What is the key take-home message for physicians?

Crowley: The paper underscores that physicians should be allowed to make a reasonable income that will enable them to stay in business and serve patients. Ultimately, physicians have a responsibility to their patients to provide high-quality care, and business interests shouldn’t compromise that trust.

Healio Primary Care: Has the pandemic influenced the commercialization of health care? If so, how?

Crowley: It’s clear that we need to do more to invest in the public health infrastructure to prevent or prepare for the next crisis, even if it’s not necessarily profitable in the short term. Also, a lot of private insurers have stopped waiving cost sharing for COVID-19 treatment, even though the pandemic is far from over. Decisions like this highlight why we need to take action to achieve comprehensive, universal coverage.

Healio Primary Care: What safeguards should be implemented in for-profit centers to ensure standard of care is not or will not be compromised, specifically for low-income populations or groups impacted by health disparities?

Crowley: For starters, we need more research to better understand the effects of for-profit conversion and private equity investment, and there needs to be oversight to prevent potential negatives from happening. The paper does recommend that for-profit hospitals adopt uniform fair pricing and financial assistance policies so that low-income or uninsured patients aren’t stuck with massive bills.

Healio Primary Care: You reference a 1986 paper with warnings regarding for-profit enterprise in health care, yet the problem had grown in magnitude since. What do you expect the next couple of decades will look like in terms of for-profit health care and pharmaceuticals?

Crowley: One of the authors of the 1986 Institute of Medicine paper was a physician named Arnold Relman. He was concerned that the U.S. health care system was turning into a “medical-industrial complex,” and in some ways, he was right. But things can change. The surprise billing issue is one of the more outrageous aspects of profit-oriented health care, and Congress has taken action to address it. Also, there seems to be bipartisan outrage over prescription drug prices, so hopefully some real change can happen there.

ACP’s Better is Possible project is the college’s prescription for achieving universal coverage, lower health care costs, payment and delivery system reform, and improving the public health infrastructure.

References:

ACP. ACP says profit motive in medicine may contribute to a broken health care system. https://www.acponline.org/acp-newsroom/acp-says-profit-motive-in-medicine-may-contribute-to-a-broken-health-care-system. Accessed Sept. 7, 2021.

Crowley R, et al. Ann Intern Med. 2021;doi:10.7326/M21-1778.