Question

1) the issue of physician-induces demand

2)self-dealing and kickbacks

For each of these two areas, briefly explain the nature of the problem, followed by a review of the methods for dealing with the problem that have been tried or recommended.

Answer 1

1) Issue of Physician induced Demand:

Nature:

One of the most important subjects in health economics and healthcare management is the theory of induced demand. There are different views about the concept of induced demand.

The hypothesis of induced demand reviews the relationship between physicians and patients. Since the patient does not have enough information to determine what services to be used, the physician can use his additional information to encourage the patient to use unnecessary medications and healthcare. Understanding the agency relationship between physicians and patients is vital to health economics. More focus in the texts is on the subject that physicians act for their patients as perfect agencies. And if it is so, they can convince their patients to act in a manner that can be beneficial to physicians too.

Methods to Deal with the Problem:

The method of the analysis of the data is based on thematic analysis. Data analysis stages included extraction of data, writing them on article, storing them in the computer, immersion in the data, coding, reflexive remarks, marginal remarks, memoing, and developing preposition. In the first stage after each interview, the text was transcribed, then, typed and stored on a computer immediately. In the next stage, the interview texts were examined and reviewed several times so that the researchers dominated the data. In the third stage, the data was categorized into semantic units (code) in the form of sentences and paragraphs related to the main meaning. Semantic units were also reviewed several times. Then, an appropriate code was written down for each semantic unit. In a way that in each interview, sub-themes were separated, and then integrated, and reduced. At last, the main themes were recognized. Reflective and marginal rein fact, ideas and viewpoints emerging in the researcher's mind was recorded during the interview and analysis. These signs related the notes to the other parts of the data.

2)Self-Dealing and Kickbacks:

Self-dealing is when a fiduciary acts in their own best interest in a transaction rather than in the best interest of their clients. It represents a conflict of interest and an illegal act, and can lead to litigation, penalties, and termination of employment for those who commit it.

A kickback is a form of negotiated bribery in which a commission is paid to the bribe-taker in exchange for services rendered. Generally speaking, the remuneration (money, goods, or services handed over) is negotiated ahead of time.

Methods:

Two of the most important fraud laws that regulate doctors and healthcare providers are the Anti-Kickback Statute and the Physician Self Referral Law (Stark Law). These laws prohibit physician self dealing and kickbacks in return for referrals. Violations of these laws can result in huge whistleblower awards and sometimes prison for offenders.

Kickbacks are one of the most common forms of government corruption. In some cases, the kickback takes the form of a "cut of the action," and can be so well-known as to be common knowledge—and even become part of a nation's culture. For example, in Indonesia, President Suharto was publicly known as "Mr. Twenty-Five Percent" because he required that all major contracts throughout the nation provide him with 25 percent of the income before he would approve the contract. And, in Pakistan, President Asif Ali Zardariwas publicly known as "Mr. Ten Percent" for the same reason, which later became hundred percent. After coming into the government, he started taking 10% of all major contract investments before he would approve the contract. However, kickbacks differ from other forms of corruption, such as diversion of assets, as in embezzlement, because of the collusion between two parties.

Kickback schemes can be pervasive. For example, in the United States, companies providing medical services to Medicare patients were paying doctors to send patients to them, whether the patient needed the treatment, diagnosis, or test or not. In 1987, the United States Congress passed the stringent Anti-Kickback Act to prevent such schemes.

In Italy, the political scene was realigned dramatically by the Tangentopoli scandals in the 1990s, which uncovered widespread use of kickbacks in the national and local governments.