"Medicine has become monetized, which is not necessarily all good or all bad," says Dr. Mark W. Dirsmith, professor of accounting in Penn State's Smeal College of Business Administration.
The old question asked of patients entering a hospital emergency room was, "Where does it hurt?" followed by "Are you insured?" Today's question is "What type of insurance do you have?"
"Doctors are being transformed from physical professionals to fiscal decision makers," says Dirsmith. "The field is also very crowded with shadow people -- insurance people, employee benefits people."
At for-profit hospitals, doctors no longer make decisions based on the diagnosed illness and the available medical knowledge, drugs and technology. They now must consider who is going to pay for whatever treatment is prescribed and make decisions in consultation with HMO personnel.
"One good is that cost containment has been achieved," Dirsmith told attendees today (Aug. 24) at the American Sociological Association meeting in San Francisco. "However, it is the progressive hospitals that benefit."
He notes that the poor, the underinsured, the old and the young are going to hospitals that are not profit-based, perhaps not as progressive or up-to-date, but are more willing to provide service.
On the other hand, consolidation and economy in medicine has led to the proliferation and availability of very expensive, high technology tools for treatment and diagnosis, such as CAT scans and MRIs.
The researchers, who include Dirsmith, Dr. Sajay Samuel, assistant
professor of accounting at Bucknell University and Dr. Barbara McElroy,
assistant professor of accounting
Contact: A'ndrea Elyse Messer