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Phoenix Forward

3 common ethical dilemmas health administrators face

Ethical dilemmas are often an integral part of health care administrators’ decision-making.

Being a health administrator can be like walking a tightrope — precariously balancing business needs and patients' needs. On the one hand, they must decide how to allocate resources that will positively impact revenue and efficiencies. On the other hand, those decisions must be weighed against the effects on the lives of patients in their care. All the while, they must adhere to the ethical standards of their profession when making such decisions, and ensure that health care providers who work in their facilities do the same.

“Up to 90 percent of our work as health administrators is driven by ethical considerations,” says Alex Kadrie, PhD, lead faculty and mentor in the health administration program at the University of Phoenix Houston Campus. He identified three common types of ethical dilemmas faced by health administrators in their day-to-day work:

1. Conflicts of interest

“Many physicians have financial relationships with pharmaceutical and medical equipment companies that can lead them to make treatment recommendations that may not be in the best interest of the patient,” says Kadrie. “That is a conflict of interest. Some medical facilities will push unnecessary tests and procedures in the interest of generating more revenue. These practices then lead to higher health care costs for everyone.” Administrators at many academic medical research centers have recently prohibited physicians from entering into financial relationships with such companies due to ethical concerns, according to Kadrie.

2. Professional obligation to provide appropriate medical care versus cost management

“Health administrators often tell me that financial pressures are preventing them from adhering to our professional and ethical obligation to provide care for all,” Kadrie says. The weak economy can steer nonprofit community hospitals away from treating the uninsured, and can even affect organ transplant decisions, according to Kadrie. “Some hospitals are moving people, who are willing to pay upfront cash, to the top of the waiting list for organ transplants,” he says. “Health administrators need to develop systematic policies to address this issue in a transparent manner.”

3. Patient autonomy

These days, more patients question or even refuse to comply with doctors’ and hospitals’ orders than in past eras, and that can lead to administrative challenges, according to Kadrie. “We must always consider patient autonomy when making policy decisions,” he says. “Patients may refuse certain treatments or want life support terminated even when their family members do not, and that can lead to legal challenges." Further, from a business perspective, there are difficult ethical decisions to make regarding care despite what the patient or the family may want. For example, should a hospital continue using scarce health care resources to care for the terminally ill, or should it instead allocate them to treat patients who have a chance of recovery?

The current economic environment provides daunting ethical challenges for health administrators. “As health care becomes an increasingly business-focused industry, we must always remember to carefully weigh patients’ best interests when making our decisions,” Kadrie says. “In an age of increasing health care demand and dwindling resources, our job is not always going to be easy.”