Abstract
The first Code of Medical Ethics promulgated by the American Medical Association (AMA) in 1847 included a provision that essentially obligated physicians to care for those in their communities who could not afford to pay for professional services. The spirit of that provision remains embodied in today’s Code. However, a “charity care” ethical obligation may not make as much professional sense as it once did. Health care institutions have assumed a much greater role in providing charity care and many physicians are now under legal and quasi-legal obligations to provide care in some cases. Under the recently enacted Affordable Care Act (ACA)—if fully implemented—it is theorized that as many as 95% of Americans will be covered by some basic insurance plan. Perhaps today’s physicians should tailor the charity care mandate into a new jacket, which envisions that all doctors share equally in the care for those without adequate means. An individual obligation may have to make way for a more communal one in professional codes. Moreover, it may be wise to consider if there are any lessons to draw from other health care systems (e.g., the Dutch), where questions about charity care still exist within a universal health care system context.
Highlights
A recent article in The New York Times by Abby Goodnough titled “Hospitals Look to Health Law, Cutting Charity” [2] included several surprising points: “In St
Trainor, [Southern New Hampshire Medical Center system] vice president of finance.”. These headlines deal with hospital charity care, but the same pattern has been emerged in physician charity care as well [3]
Even with the recent enactment and partial implementation of the 2010 Affordable Care Act (ACA) which was crafted to provide some form of health insurance protection to about 95% of Americans as designed, the number of remaining persons in the US who will be uninsured or under-insured will certainly overwhelm any informal physician charity care net
Summary
A recent article in The New York Times by Abby Goodnough titled “Hospitals Look to Health Law, Cutting Charity” [2] included several surprising points:. The local physicians should be able to turn for assistance to their colleagues in prosperous communities, those in close proximity Physicians are meeting their obligation, and are encouraged to continue to do so, in a number of ways, such as seeing indigent patients in their offices at no cost or at reduced cost, serving at freestanding or hospital clinics that treat the poor, and participating in government programs that provide health care to the poor. The recent enactment and partial implementation of the Patient Protection and Affordable Care Act (ACA) in 2010, which creates new care opportunities [6], only exacerbates these concerns [7] Given these developments and evolving physician practice patterns, it may be prudent to re-examine the referenced individual physician’s charity care obligations, with an eye towards either its elimination or re-wording to allow for a more modern conceptual interpretation or revitalization. A brief comparison with the Dutch health care system will illustrate that a comprehensive health care model still needs some regulatory infrastructure for “charitable care”, even when there is a funded unambiguous communal obligation underpinning the system
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