Managerialism and medical charity: How employing and pre-paying doctors affects the provision of free care in the United States

摘要

Since the mid-nineteenth century, the American Medical Association's code of ethics has mandated that physicians provide charity care. However managerialism has threatened the likelihood of physicians' providing charity care. Specifically, physicians who recently became employees, or whose revenue became predominantly pre-paid, also became less likely to provide free care. Moreover, physicians with an increased proportion of revenue from Medicaid, or in counties with high Medicaid managed care penetration, were less likely to provide charity, perhaps due in part to a reduced ability to cost-shift. Despite upcoming health reform, managerial strategies that employ or pre-pay physicians are likely to leave many millions of uninsured without access to charity care from physicians.