Changes in Clinical Practice in Response to Reductions in Reimbursement

Physician Autonomy and Resistance to Bureaucratization

Dados Bibliográficos

ID7199457
AutoresKaren L Posner (0000-0001-6802-551X, University of Washington), William M Gild (University of Washington), Edgar V Winans (University of Washington)
Ano1995
Volume9
Fascículo4
Páginas476-492
Data de publicação1995-12-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoMedical Anthropology Quarterly (JOURNAL)
Identificadores do periódicoISSN: 0745-5194 • E-ISSN: 1548-1387
EditoraWiley (PUBLISHER • GB)
DOI10.1525/maq.1995.9.4.02a00040
PMID8748474
OpenAlexW2106447004
IdiomaEN
Citações recebidas5
Referências citadas23

This analysis of field data from 1991 and 1992 examines the process of joint decision making between cardiothoracic surgeons and anesthesiologists in a U.S. hospital as they made changes in clinical practice in response to reimbursement reductions. Although these physicians have concurrent responsibility for patient care in the operating room, their domains of authority are ambiguous. Much clinical decision making was found to be based on charismatic authority. In making practice changes, cardiothoracic surgeons maintained all and anesthesiologists most of their charismatic authority, expanding the conventional range of physician practice while prescribing specific practices for nonphysician providers. Ambiguity of joint physician authority over patient care was left unresolved, and the economic goals of the practice changes were not realized. Physicians resisted the bureaucratic claim to authority rooted in cost accounting by resorting to the need for nonroutinized clinical decisions

Autonomy · Bureaucracy · Clinical Practice · Health care · Managed care · Political science · Public relations · Reimbursement · Resistance (ecology · Healthcare Policy and Management · Healthcare Quality and Management · Law · Medicine · Nursing · Patient Satisfaction in Healthcare