The courtship of the paying patient.

This article argues for a prohibition on the courtship of the paying patient by individual practitioners, groups, institutions, and corporations. Our society fails to provide universal access to health care. While we await societal resolution, the private provider retains partial responsibility for addressing issues of distributive justice. All private physicians, groups, institutions, and corporations should offer a fair share of underreimbursed, nonemergency care. If economic survival or beneficent economic commitments of a provider are at risk, the provider may explicitly limit underreimbursed services by a rational system of accepting or rejecting nonemergency, indigent patients. The system should be one that, if implemented by all providers, would meet regional societal needs. One might analyze the issue of courtship of the paying patient as a problem of distributive justice. The desire of paying patients to receive personalized care or nonmedical amenities and to have the freedom to buy the best possible medical care, and the economic interests of the providers (the desire of the already affluent provider to seek further gain and growth, the need of a threatened provider to survive, and the dependency of educational institutions on patient payments) all conflict with distributive justice. The marketing interest of providers conflicts with the greater need of the poor to receive information about health, and it conflicts with public need for protection against misleading solicitation. The possibly higher per capita cost of treating the poor, along with possibly lower success rates, create a conflict between cost-effective allocation of limited resources, on the one hand, and egalitarian distributive justice, on the other. The competitive market principle may even protect, rather than defeat, the principle of justice. The author, however, writing from the point of view of the physician, has analyzed the question in terms of a conflict between the economic interest of the physician (perhaps as agent of his group, institution, or corporation) and the trustworthiness of the profession. The courtship of the paying patient represents a failure of the professional virtues of truthfulness, loyalty, and respect for persons.