Question: REALITY CHECK: States Have Double Standards It's no secret that the states have had double standards over the years, one for health care organizations and one for physicians. For example, a physician is able to buy his or her own computed tomography (CT) scanner, while hospitals have to jump through hoops to be able to purchase one. Physicians are allowed to establish surgery centers near hospitals without scrutiny, while hospitals have to beg and plead with state health departments for months and sometimes years, requiring mountains of documentation and meetings, to justify opening an outpatient surgery center. In one true-life example, a 300-bed hospital had to justify opening an outpatient rehabilitation program within the hospital in order to provide a continuum of care for patients. While the hospital was busy arguing with the state to justify this outpatient program, physician groups were busy setting up their own outpatient programs in direct competition with hospitals. Physicians often duplicate the money-making health care programs that hospitals develop, while referring Medicaid and no-pays to hospital programs for care.

1. Discuss the issues of justice as they apply to this scenario.

2. Discuss the issues of fairness and how physician competition with hospitals might affect the quality of patient care.