Health care, "thank you" gifts and corruption

[Grinning_Colossus]

The same thing happens in the U.S. -- you have to give doctors a lot of cash if you want medical care.

[Valmy]

The same thing happens in the U.S. -- you have to give doctors a lot of cash if you want medical care.

Yeah the bribes are getting pretty steep these days

[Fate]

In most US states there are no official rules on the matter, but our professional organizations state that you should refuse personal gifts of more than $100. I think the true purpose of gift rules is to limit the degree to which pharmaceutical companies can influence physicians rather than prevent patient appreciation.

[Admiral Yi]

In most US states there are no official rules on the matter, but our professional organizations state that you should refuse personal gifts of more than $100. I think the true purpose of gift rules is to limit the degree to which pharmaceutical companies can influence physicians rather than prevent patient appreciation.

I can also see an incentive in preventing the appearance of scheduling favoratism.

[Fate]

i don't get how it's a bribe if it's after the fact. Unless it was a wink wink sort of way to try to get around the bribe. ie it was set up before the operation but paid out after the operation. it's also weird to distinguish between cah and non-cash. i mean, what the difference between getting 300 dollars or a 300 dollar bottle of cognac.

In the US it's illegal to reimburse a doctor at greater than Medicare rates if you're on Medicare. I can see where you could start to run afoul of the limit with expensive gifts from elderly patients.

Ethically there's problems with expensive gifts because your other patients may see such gifts and assume you're not providing the same level of care if a gift isn't provided.

[Malthus]

i don't get how it's a bribe if it's after the fact. Unless it was a wink wink sort of way to try to get around the bribe. ie it was set up before the operation but paid out after the operation. it's also weird to distinguish between cah and non-cash. i mean, what the difference between getting 300 dollars or a 300 dollar bottle of cognac.

I agree it's wierd to distinguish the two.

I think the "before the fact" and "after the fact" issue is this: in at least some cases, patients are likely to see physicians (even specialists) more than once. If you have received a very expenisve "gift" last time you saw the patient, the concern is that next time they need your services you will treat them better than the patient who did not give a gift - like scheduling them sooner. If this becomes known, the pressure is on to give gifts.

[Martinus]

Well, while I agree the distinction is blurry, cash is more of a naked bribe whereas an expensive gift but one that cannot be easily resold and does not have an inherent utility is more acceptable. It's like buying someone flowers - it can be viewed more as a token of appreciation, no matter the cost.

[Martinus]

Once it ceases to have a purely monetary value (i.e. something that can either be exchanged for cash or is something the doctor buys regularly so saves him cash) it becomes more of a potlach thing - "I am burning cash to show my appreciation for you but you are not being effectively enriched, even if you technically receive a good of some value."

Imagine a situation if a famous opera singer, happy with the result of a surgery, performed for the doctor at a private soiree. This would probably have high value, technically (perhaps the singer's fee for such private performances goes into tens or hundreds of thousands) but since this is not something the doctor would have otherwise commissioned, one cannot say he actually saved/received a cash value.

[Martinus]

For the record, I am not saying that having the singer sing for you is the same as getting a bottle of cognac, but that there is a gradual scale there and not a purely binary situation.

[Malthus]

Once it ceases to have a purely monetary value (i.e. something that can either be exchanged for cash or is something the doctor buys regularly so saves him cash) it becomes more of a potlach thing - "I am burning cash to show my appreciation for you but you are not being effectively enriched, even if you technically receive a good of some value."

Imagine a situation if a famous opera singer, happy with the result of a surgery, performed for the doctor at a private soiree. This would probably have high value, technically (perhaps the singer's fee for such private performances goes into tens or hundreds of thousands) but since this is not something the doctor would have otherwise commissioned, one cannot say he actually saved/received a cash value.

The issue though isn't the cash value, but whether the doctor is likely to be influenced in the exercise of his or her professional judgment - for example, to scedule the opera singer's surgery next time ahead of some schlub who didn't give the surgeon a fancy gift last time around, even though the schlub's medical condition etc. would normally rank him higher on the priority list.

[Josquius]

a friend of mine is a nurse in the UK. just the other day she was telling me about a absolute bitch Filipina nurse she has to work with. given hints the bitch has dropped my friend heavily suspects a lack of bribes and tips from the patients in the UK is a key source of her bitch powers.

[garbon]

a friend of mine is a nurse in the UK. just the other day she was telling me about a absolute bitch Filipina nurse she has to work with. given hints the bitch has dropped my friend heavily suspects a lack of bribes and tips from the patients in the UK is a key source of her bitch powers.

[HVC]

Translation: "She's cranky about not getting bribes"

[Fireblade]

Martinus rationalizing bribery. Yep, he's definitely a Jew lawyer.

[mongers]

a friend of mine is a nurse in the UK. just the other day she was telling me about a absolute bitch Filipina nurse she has to work with. given hints the bitch has dropped my friend heavily suspects a lack of bribes and tips from the patients in the UK is a key source of her bitch powers.

Makes perfect sense if you read it aloud.