Shifting Priorities and Values: A Challenge to the Hospital’s Mission

  • Marc D. Hiller
  • Robin D. Gorsky
Part of the Philosophy and Medicine book series (PHME, volume 21)


What should be the driving force underlying the health care industry in the United States as the twenty-first century approaches? Should it be to maximize the quality of health care and availability of resources for the population or to maximize the return on investment through pricing and service policies? This dichotomy poses what possibly may be the most complex and far-reaching issue ever to confront the American health care system. Thus far, most of the debate on this issue has centered either at the societal (macro) level where questions of access to medical care are addressed, or on the individual patient care (micro) level, involving obligations within the context of the provider-patient relationship. Often overlooked in such discussions has been the institutional, or meso, level ([17], pp. 7—9; [18]). This level concerns the responsibilities of those who manage health care institutions, namely administrators. The classic dilemma arising at this level is the conflict between the traditional charitable healing mission of the health care institution, which is oriented toward benefiting patients without recognizing a limit to resources, and the so-called business ethic, which is geared toward maximizing institutional solvency and, in a growing number of cases, profitability [8].


Moral Agent Health Care Institution Hospital Administrator Hospital Industry Health Care Industry 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© D. Reidel Publishing Company 1986

Authors and Affiliations

  • Marc D. Hiller
    • 1
  • Robin D. Gorsky
    • 1
  1. 1.University of New HampshireDurhamUSA

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