Rethinking professional ethics in the cost-sharing era

G. Alexander, Mark Hall, John Lantos

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


Changes in healthcare financing increasingly rely upon patient cost-sharing to control escalating healthcare expenditures. These changes raise new challenges for physicians that are different from those that arose either under managed care or traditional indemnity insurance. Historically, there have been two distinct bases for arguing that physicians should not consider costs in their clinical decisions - an "aspirational ethic" that exhorts physicians to treat all patients the same regardless of their ability to pay, and an "agency ethic" that calls on physicians to be trustworthy advisors to their patients. In the setting of greater patient cost-sharing, physicians' aspiration and agency roles increasingly conflict. Satisfactorily navigating the new terrain of consumer-driven healthcare requires physicians to consider these two roles and how they can best be reconciled so as to maximize quality of care while respecting the heterogeneity of patients' financial resources and willingness to pay.

Original languageEnglish (US)
Pages (from-to)W17-W22
JournalAmerican Journal of Bioethics
Issue number4
StatePublished - Aug 1 2006
Externally publishedYes


  • Out-of-pocket costs
  • Patient-physician communication
  • Professional ethics

ASJC Scopus subject areas

  • Issues, ethics and legal aspects
  • Health Policy


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