Business vs. Medical Ethics: Conflicting Standards for Managed Care
Mariner, Wendy K.
Journal of Law, Medicine and Ethics. 1995 Fall; 23(3): 236-246.
...This article explores the difficulty of adopting ethical standards for MCOs. First, it is not clear what counts as an ethical standard for an organization. The ideals of quality and efficiency are desirable goals but do not describe how they ought to be achieved. The ethical principles that promote free and fair competition are quite different from the ethical principles that preserve the integrity of the physician-patient relationship and specifically those that protect patient welfare, and these principles can lead to quite different outcomes. MCOs were created to achieve economic objectives that may be fundamentally incompatible with traditional principles of medical ethics. Moreover, in today's open-ended health care system, it is questionable whether American economic institutions are susceptible to purely moral suasion. Thus, even if it is possible to agree that certain ethical principles ought to apply to managed care, the market may make it impossible to live fully by those principles. Finally, it is important not to mistake ethical managed care for an ethical national health care system. Good MCOs may be able to provide efficient, high quality care; but, in the long run, they are not likely to be able to do so and simultaneously cut costs and promote equitable access to care. If the analysis presented here is correct, then we have a choice: either abandon the goal of universal access to health care, or regulate the health care system by eliminating those marketplace standards that conflict with equitable access to care.
Administrators; Access to Health Care; Business Ethics; Conflict of Interest; Contracts; Disclosure; Economics; Employment; Ethics; Freedom; Goals; Health; Health Care; Health Care Delivery; Health Maintenance Organizations; Institutional Ethics; Insurance; Medical Ethics; Moral Obligations; Managed Care; Organizations; Professional Ethics; Resource Allocation; Standards; Values; Withholding Treatment;
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