Ethical Issues in Managed Care
Although the term “managed care” refers to a rather heterogeneous group of institutions, a feature common to all managed care organizations (MCOs) is a systematic approach to controlling what had been a skyrocketing escalation in the country’s healthcare costs. The increasing prominence of both medical ethics and managed care over the past three decades has resulted in, if not a head-on crash, a number of well-publicized collisions between the two. Managed care, on the other hand, has clearly concerned itself with the health of not only individual patients, but the collective health of a defined population, namely the MCO’s membership or so-called “medical commons.”
Relevant Principles of Medical Ethics
There are six principles of medical ethics with special relevance to managed care:
Autonomy refers to 1) a person’s right to be fully informed of all pertinent information related to his/her healthcare, and 2) the person’s additional right to choose or refuse among the available treatment options.
Beneficence is the commitment to “do good.”
Nonmaleficence is the commitment to “do no harm.”
Fidelity is the notion that the physician should be faithful and loyal to the individual patient.
Veracity refers to the physician’s responsibility to be truthful to the individual patient.
Justice implies that all patients should be treated fairly, without regard to their race, ethnic background, socioeconomic status, or educational level.
Ethical Issues Faced by MCO Managers
MCO executives face a variety of ethical challenges on an ongoing basis. Some of these ethical dilemmas are analogous to those faced by physicians, whereas others are quite different.