Protecting Patient Welfare in Managed Care: Six Safeguards
Emanuel, Ezekiel J.
Journal of Health Politics, Policy and Law. 1998 Aug; 23(4): 635-659.
The public is very suspicious and fearful that managed care threatens their health because of its interest in reducing costs. Because physicians' decisions control 75 percent of all health care spending, managed care organizations are focusing their cost-cutting strategies on influencing physician decision making through financial incentives and guidelines. These two techniques have had some important contributions, especially in enhancing efficiency and standardizing care to a high level. Nevertheless, they pose a threat -- and are perceived by the public to pose a threat -- to patients' health and well-being. How can we mitigate the threats to patient welfare posed by financial incentives and guidelines? We propose and analyze six safeguards. These safeguards are not an attempt to revive the fee-for-service system, but an effort to make managed care ethical and to focus it on improving patient welfare. They are designed to work together to ensure that patient welfare remains the primary focus of managed care organizations; they try to create institutional structures that emphasize quality over mere cost reductions.
Accountability; Conflict of Interest; Decision Making; Disclosure; Due Process; Economics; Entrepreneurship; Ethics; Guidelines; Health; Health Care; Health Services; Health Services Misuse; Incentives; Institutional Policies; Managed Care Programs; Mandatory Programs; Medical Ethics; Managed Care; Organization and Administration; Organizations; Patients; Physician Self-Referral; Physician's Role; Physicians; Practice Guidelines; Quality of Health Care; Quality Assurance; Regulation; Remuneration; Resource Allocation; Review; Review Committees; Self Regulation; Standards; Trust; Withholding Treatment;
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Emanuel, Ezekiel J.; Dubler, Nancy Neveloff (1995-01-25)Even without comprehensive health care reform legislation, the US health care system is undergoing significant changes. Probably the most important change is the expansion of managed care with significant price competition. ...