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June 1976 (Volume 54)
M. David Ermann
Milbank Memorial Fund
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Available data suggest that the influence and autonomy of health care professionals have been declining. Of course, professional impact remains higher in health care than perhaps any other economic sphere, but the locus of much health care decision making has been shifting from independent professionals to employed personnel of large-scale governmental, hospital, insurance, and research organizations. The question therefore arises as to what shall replace this previous reliance upon individual professional ethics to assure the society that its newly powerful health care organizations are functioning in a desirable manner. In other words, what are to be the preferred mechanisms for socially controlling health care organizations. This paper traces three dominant belief patterns about how the characteristics of health care organizations and their environments produce desired control. It proposes that belief patterns have emphasized (1) the non-profit motives of many health care organizations; (2) the system of interrelationships that surround health care organizations; and (3) the vast differences among health care consumers. Choices from among these models continue to depend less upon knowledge of organizational functioning than upon political dispositions and social fancy.
Author(s): M. David Ermann
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Volume 54, Issue 2 (pages 167–183) Published in 1976
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