Financial Incentives for Organ Donation: The Perspectives of Health Care Professionals

Abstract

Physician Fraud and Medicaid Physician Fraud and Medicaid Physician Fraud and MedicaidTo the Editor. \p=m-\Thearticle "Fraud by Physicians Against Medicaid" by Jesilow et al1 is seriously misleading. Its main conclusion, appearing in the abstract, is that "sanctioned physicians show an overrepresentation of psychiatrists, foreign medical graduates, and minority group physicians." The text of the article does not substantiate this conclusion. The authors do not, in fact, provide additional information other that of 138 physicians, sanctioned by Medicaid between 1977 and 1982, slightly more than one third were international medical graduates; blacks and psychiatrists were also overrepresented.The key issue here is the term overrepresentation. As the article stands, it leaves the impression that these minority physicians cheat more than their mainstream counterparts. Representation, however, or representativity, can only be defined with regard to a population. If the population is that of all physicians, then one third of international medical graduates would indeed be disproportionate. It is known, however, that in the population of the providers to Medicaid, whether measured in number of active physicians or in billing amounts, minorities are also overrepresented, perhaps ex¬ tremely so. Thus, the claim of the article is meaningless at best, false and misleading at worst, if not accompanied by comparative data on the proportion of minorities among Med¬ icaid providers.Having failed to substantiate the main specific claim made in the abstract, what is left in the article? That cheaters and lawbreakers usually find excuses and that law enforcers usu¬ ally do not accept them. Unfortunately the JAMA Editorial2 endorses the article the statement: "Fortunately these physicians do not repre¬ sent the mainstream of American medicine." This Editorial elevates what was, in principle, a study of fraud in Medicaid to an identification of "the worst in the profession." It tends to perpetuate the stereotype that it is in the minority groups of professionals where the largest frauds and crimes are committed. There is not even an attempt to compare fraud to Medicaid with that to private insurers or Medicare.Neither the editor nor the authors realize how deeply they have hurt and offended those physicians in the minority groups, which are the ones "overrepresented" in the care of the disadvantaged and the needy of our society.In Reply.\p=m-\Dr Rios makes several excellent points in her letter regarding our article that appeared in JAMA. We strongly agree with her contention that international medical graduates and minority groups are overrepresented among sanctioned physicians because they are overrepresented "in the care of the disadvantaged and the needy of our society." Enforcement agents, were they to investigate physicians accepting private insurance, Medicare, or direct payment, might well find that these physicians offend as often as do minority physicians practicing in poor areas.Psychiatrists are overrepresented among san...

Procurement and Allocation of Solid Organs for Transplantation

“…The refusal to provide consent continues to be a major barrier in procuring organs. 14,18,70,[108][109][110] Although multiple surveys of both the general public 1,111 and health care professionals 71,72,112,113 have shown a willingness to donate organs, these results may not predict actual consent rates. 1,70,114 Hospital characteristics, 110,115 the timing of the request, 14,109,115 the background of the requester, 72,116,117 and the demographic characteristics of potential donors and their families 118-120 may influence consent rates.…”

Attitudes Toward Strategies to Increase Organ Donation

“…Surveyed health professionals in transplantation have suggested previously that providing incentives to the family or potential donor may increase the number of potential donors (20,27) and found similar support for financial incentives similar to those studied here (28). The lack of acceptability of certain financial incentives, notably monetary payment, by health professionals may stem from their comfort level in discussing donation with families once financial incentives are offered (33) or their perceived "moral inappropriateness" of offering cash (20). Further, it is interesting to note that whereas a tax credit is akin to monetary payment in terms of value in this survey, there were notable differences in preferences for the two forms of financial incentives across the different groups.…”

Altruism, Incentives, and Organ Donation

“…Third, although the findings of studies 20,34,35 in this area are somewhat mixed, support for financial incentives among at least some healthcare professionals seems to be increasing over time. For example, in 1987, Altshuler and Evanisko 20 found that 10%, 16%, and 8% of neurosurgeons, organ procurement coordinators, and critical-care nurses, respectively, supported offering incentives to donor families.…”

“…20 -26 Empiric evidence to support either of these opposing positions, however, is scant. Few studies have examined the attitudes of either the public 10,11,[27][28][29][30][31][32][33] or healthcare professionals 20,34,35 toward incentives for organ donation. These studies typically focus on the general category "financial incentives" rather than on specific incentives and thus their results are difficult to interpret.…”