How stakeholders affect change in healthcare

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Physicians are the providers of medical care; patients are the recipients. And government subsidizes healthcare for the elderly, the disabled, and the poor. All stakeholders have duties and responsibilities.

Clearly, the interrelationship among the stakeholders in the healthcare system is rather complex. Two of the stakeholders, pharmaceutical firms and insurance companies, are publically owned corporations listed on the stock exchange. Their primary responsibility is to maximize stockholder wealth. Likewise, the primary goal of employers is to make money; however, their provision of health insurance for employees is a benefit, not a source of profit. Unlike the other stakeholders, physicians have direct fiduciary duties and responsibilities toward their patients.

Although they receive remuneration for their services, the doctor-patient relationship is a sacred trust that transcends monetary reward. Patients have rights, duties, and responsibilities. Finally, democratic government has duties and responsibilities towards its citizens, but how they are defined in regard to the provision of healthcare is an evolving American story. Currently, rising premiums and strict requirements are keeping many people from obtaining health insurance. Insurance companies remain profit-driven, but the nature of their service should not be profit-focused.

Adequate healthcare is becoming harder to obtain due to financial hardship. Insurance companies need to find an appropriate balance between their responsibilities towards both shareholders and patients.

Quarterly reports for stockholders encourage the companies to focus more on profits than affordability. This causes insurance companies to have tight regulations against preexisting conditions so that most healthy individuals are selected for their plans. Such patients will not utilize costly procedures as often as individuals with chronic illnesses. However, this is unethical of insurance companies because it reduces healthcare to a profit-centered industry, and prevents those in need from receiving care.

Pharmaceutical companies also play a key role in the healthcare system because many patients rely on their products. The prices for drugs are rising, and there are no caps to prevent them from reaching extravagant prices. The argument that pharmaceutical companies need to charge ever-higher prices to cover research costs is simply not true. Whether or not you argue that pharmaceutical companies have a moral responsibility to ensure that people can afford their products, at the very least they have the duty, to be honest, and practice fair marketing.

Marcia Angell, previously an editor of the New England Journal of Medicine, has written extensively about the unethical behaviors of pharmaceutical companies. Let me cite one example. Through personal experience, the author who had an office practice since the early s witnessed a sinister change in the way pharmaceutical companies market their products to physicians. Previously they sent pharmacists with a depth of knowledge about their products to objectively educate the physician about the benefits and risks of a particular brand of medication.

However, since the late s pharmaceutical firms send young attractive representatives with no formal training to market their drugs by establishing a social relationship with the physician and by offering incentives to prescribe their product. Many physicians whose prescribing practices are unduly influenced by pharmaceutical representatives share the blame. They tend to respond to conversations about certain drugs rather than reading biomedical literature. Physicians play a key role in ensuring that their patients receive adequate healthcare, but also in controlling the rising costs of healthcare.

They have to find a balance between having a gatekeeper role for the insurance companies and being an advocate for the patient.

Assigning a gatekeeper role to primary care physicians had the intention of lowering healthcare costs because fewer tests and referrals would be made. However, this is not working and it may be best to re-evaluate the role a primary care physician has in regard to referring patients.

A coordinator role may be more beneficial than a gatekeeper status. Also, since primary care physicians have increased the number of patients seen in a day to compensate for their decrease in revenue, this causes an increase in defensive diagnostic testing. Methods: This single case study included two site visits, semistructured individual tape-recorded interviews, and the examination of relevant public documents. Qualitative content analysis was used to analyze the data.

Results: Sixteen individuals from different healthcare sectors and professions participated in the interviews and 20 documents were reviewed. Six key themes emerged from the data. Linking Evidence to Action The findings from the study present a new perspective on stakeholder participation that includes both those who supported the proposed change and those who advocated for a different change.

The findings identify stakeholder activities used to shape, share, and protect their visions for system change. The conceptual model presented in this study adds to the understanding of challenges and complexities involved in healthcare system change.