Ethical Practice in Managed Care: A Dose of Realism
Hall, Mark A.
Berenson, Robert A.
Annals of Internal Medicine. 1998 Mar 1; 128(5): 395-402.
This article examines the ethics of medical practice under managed care from a pragmatic perspective that gives physicians more useful guidance than do existing ethical statements. The article begins with a framework for constructing a realistic set of ethical principles, namely, that medical ethics derives from physicians' role as healers; that ethical statements are primarily aspirational, not regulatory; and that preserving patient trust is the primary objective. The following concrete ethical guidelines are presented: Financial incentives should influence physicians to maximize the health of the group of patients under their care; physicians should not enter into incentive arrangements that they are embarrassed to describe accurately to their patients; physicians should treat each patient impartially without regard to source of payment, consistent with the physician's own treatment style; if physicians depart from this ideal, they should inform their patients honestly; and it is desirable, although not mandatory, to differentiate medical treatment recommendations from insurance coverage decisions by clearly assigning authority over these different roles and by physicians advocating for recommended treatment that is not covered.
Administrators; Common Good; Conflict of Interest; Decision Making; Disclosure; Economics; Ethical Analysis; Ethics; Guidelines; Health; Health Care; Health Insurance; Health Insurance Reimbursement; Incentives; Insurance; Insurance Coverage; Managed Care Programs; Medical Ethics; Moral Obligations; Moral Policy; Managed Care; Patient Advocacy; Patients; Physician Patient Relationship; Physician's Role; Physicians; Public Policy; Remuneration; Resource Allocation; Trust; Withholding Treatment;
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