Health Care Analysis 25 (2):151-167 (2017)

Lynette Reid
Dalhousie University
In bioethics and health policy, we often discuss the appropriate boundaries of public funding; how the interface of public and private purchasers and providers should be organized and regulated receives less attention. In this paper, I discuss ethical and regulatory issues raised at this interface by three medical practice models in which physicians provide insured services while requiring or requesting that patients pay for services or for the non-insured services of the physicians themselves or their associates. This choice for such practice models is different from the decision to design an insurance plan to include or exclude user fees, co-payments and deductibles. I analyze the issues raised with regards to familiar health care values of equity and efficiency, while highlighting additional concerns about fair terms of access, provider integrity, and fair competition. I then analyze the common Canadian regulatory response to block fee models, considering their extension to wellness clinics, with regards to fiduciary standards governing the physician–patient relationship and the role of informed consent. I close by highlighting briefly issues that are of common concern across different fundamental normative frameworks for health policy.
Keywords Primary care ethics  Ethics of health policy  Organization of care  Medical practice design  Concierge medicine  Insured and uninsured services  Wellness  Public–private divide
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DOI 10.1007/s10728-016-0324-4
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Preferences, Paternalism, and Liberty.Cass Sunstein - 2006 - Royal Institute of Philosophy Supplement 59:233-264.

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