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Medicine and Public Policy |

Hippocrates and the Health Maintenance Organization: A Discussion of Ethical Issues

Gail Povar, MD, MPH; and Jonathan Moreno, PhD
[+] Article and Author Information

Requests for Reprints: Gail J. Povar, MD, MPH, Department of Health Care Services, 2150 Pennsylvania Avenue, George Washington University, Washington, DC 20037.

Current Author Addresses: Dr. Povar: Department of Health Care Services, 2150 Pennsylvania Avenue, George Washington University, Washington, DC 20037.

Dr. Moreno: Department of Philosophy, Academic Center, T520, George Washington University, Washington, DC 20037.


©1988 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1988;109(5):419-424. doi:10.7326/0003-4819-109-5-419
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Health maintenance organizations (HMOs) are providing an increasing proportion of medical care in the United States. Characteristics of these organizations such as cost containment, incentives to reduce spending by practitioners, and barriers to access for clients raise significant ethical concerns. This paper considers how these features of the HMO withstand ethical scrutiny and what may be done to prevent abuse. Generally, the challenges to the moral integrity of physicians practicing in HMOs are neither intractable nor in all cases unique, although special arrangements may have to be made to ensure that ethical standards are upheld. Independent practice associations pose particular problems. Finally, whether or not an HMO is a for profit enterprise is a significant consideration.

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