Hospital management should consider how strongly they are influenced by the promise of revenue generated by their emergency department (ED), a group from Ohio University Heritage College of Osteopathic Medicine suggests in an article published in the AMA Journal of Ethics. Relying too heavily on money generated by EDs may discourage hospital administrators from exploring programs more focused on preventive medicine.

In this article, the writers depict a hypothetical hospital that often serves members of its underserved community in its over-run but profitable ED. Hypothetical employees, including an ED resident and a hospital director, propose a community program to address community members’ asthma conditions in early stages. Doing so, they advise, would improve the health of their community members as well as decrease traffic in the ED.

The hypothetical hospital administrator, however, is hesitant to adopt this program because it would likely decrease the revenue generated by the ED. The charitable policy of the ED to treat every patient who seeks help, regardless of their ability to pay, she believes, fulfills the hospital’s ethical obligation to the community.

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This group of writers acknowledges that treating patients regardless of payment ability is part of any hospital’s code of ethics. They argue that seeking prevention for those illnesses is always preferable to administering treatment after it has become inevitable. They warn that any time medical providers view hospital services as a source of revenue, they open themselves up to potential ethics violations.

The main limitation of this discussion is that it is based on a hypothetical situation; no data were gathered or cited in this article.

The writers recognize that nearly all health care workers take the Hippocratic oath and genuinely care about patient health outcomes, needs, and the overarching ethics of the field. The types of issues they encounter, however, are complex and nuanced, and require some framework and careful consideration. The writers conclude that existing legal structures, such as Emergency Medical Treatment and Labor Act, non-profit tax code, and the Affordable Care Act are essential protectors of ethical practices. Enforcing these safeguards while considering new ideas and programs in a fast-changing medical field can drive truly patient-centered progress.


Myers A, Cain A, Franz B, Skinner D. Should hospital emergency departments be used as revenue streams despite needs to curb overutilization? AMA J Ethics. 2019; 21(3):E207-214. doi: 10.1001/amajethics.2019.207