AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. May 2000, Volume 2, Number 5.

Cases in Law and Ethics

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Must Physicians Disclose Health Plan Financial Incentives?

An ethical case explores whether a physician has an ethical or legal duty to disclose financial incentives provided through a patient's health plan.

Both ethics and law address norms that govern physicians’ behavior. Many view the law as a baseline for articulating the limits placed on individuals living within society as well as an enabling device to facilitate social relationships. Encompassing as the law may be in some areas of human conduct, in many others it is silent. In the absence of legal norms or prohibitions, physicians often find guidance in the standards arrived at through ethical reasoning.

To guide students through the process of ethical reasoning and to acquaint them with case law, a new case study will appear every 2 to 4 weeks. Students will be given legal and/or ethical opinions to assist their decision-making.

May Case Scenario

Ms Halpern is a patient enrolled in a health plan that uses various financial incentives to contain health care costs by reducing the use of expensive medical tests. One day, she presented to her physician, Dr. Pilgrim, complaining of terrible headaches over the past 2 weeks. After examining her, Dr. Pilgrim concluded that these headaches were most likely tension headaches and prescribed nonsteroidal analgesic treatment. However, Ms Halpern was concerned that these headaches might be due to a brain tumor, and would have preferred a head MRI to rule out this possibility. Even though the patient had some concerns that Dr. Pilgrim’s decision was influenced by financial incentives, she did not ask him why he made these particular decisions and agreed to go forward with his initial recommendations.

Do you think that Dr. Pilgrim has an ethical and/or legal duty to disclose financial incentives used in her health plan to his patients?

See what the AMA Code of Medical Ethics says about this topic in:

Opinion 8.053 Restrictions on disclosure in health care plan contracts. American Medical Association. Code of Medical Ethics 2008-2009 Edition. Chicago, IL: American Medical Association; 2008:222.

Opinion 8.054 Financial incentives and the practice of medicine. American Medical Association. Code of Medical Ethics 2008-2009 Edition. Chicago, IL: American Medical Association; 2008:223-225.

Opinion 8.132 Referral of patients: disclosure of limitations. American Medical Association. Code of Medical Ethics 2008-2009 Edition. Chicago, IL: American Medical Association; 2008:2275.

The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.