Managed Care Ethics

As your fourth assignment toward completion of the Session Long Project you are asked to review the paper by A. Mains, A. Coustasse, K. Lykens: Physician Incentives: Managed Care and Ethics and answer the questions below.
Consider this idea from the paper: “Medicine is a moral enterprise. Because MCOs are involved in the delivery of medical care, they too, are moral entities. However, MCOs are also businesses.”
Their economic views include not only minimizing costs for individual patients and third-party payers but creating profit for its officers and shareholders. Individual and group physician practices are businesses but they contain less shareholders requiring a profit. It is true that managed care attempts to allocate regulating decisions, which indicates an ethical way to do business. Managed care areas of quality and access
mandate physicians be both patient advocate and organizational advocate, even though these roles seem to conflict. Managed care’s moral mission is vital for permitting physicians, patients, payers and policymakers to fulfill their new role and to reserve the reliability of the doctor-patient relationship (Mains, Coustasse & Lykens, 2003).
Explain the idea that the authors sought to convey. The idea that the authors sought to convey is that managed care has the chance to initiate change from within. Managed care presents moral and professional challenges to medicine's ethics, including the fundamental values and assumed prerogatives of clinical practice. Managed care’s administrative controls have increasingly changed the doctor-patient relationship to the businessperson consumer relationship, and ethical considerations inevitably arise as a result of incentive systems in managed care, and exist at the physician-physician level (issues of professional sovereignty, conflict of interest) as well the physician-patient level (Mains, Coustasse & Lykens, 2003).
Discuss the physician’s dual function under an MCO model of care. Managed care places the primary care physician as gatekeeper with the purpose of controlling operation through the system and employs a collaborative approach to affect both clinical decisions and financial resources. Many MCOs monitor practice patterns of physicians by using programs in quality assurance and utilization management. Providers must consider the economic effects of individual clinical decisions at the same time that they must protect their traditional role of maximizing the independent clinical benefit to patients regardless of the cost. This dual decision process of providers is the crucial and central concept that lies at the heart of managed care, and it has caused the resistance of physicians, patients and ethicists (Coustasse, Mains & Lykens, 2004; Mains, Coustasse & Lykens, 2003; Navarro & Cahill, n. d.).
What concerns do you have about the physician- patient relationship under MCOs?
Conflicts of interest in managed care suggest strong concerns because valuable mediations may be withheld. Usually, physicians have been viewed as fiduciaries who are trusted to act in the best interests of the patient, not in their own self-interest or the interests of third parties. This trust may be called into question by new financial and administrative preparations. Patients may fear that physicians are no longer independent professionals but rather agents of managed care organizations or acting in their personal self-interest. On a public policy level such concerns have led to increasing regulation of managed care and discovery of financial incentives and practice guidelines. On a clinical level, patients may believe that they are more likely to receive interventions if they are unrelenting. In some cases, the doctor-patient relationship may become confrontational rather than collaborative (Lo, 1999).
The relationship between doctors and their patients has received philosophical, sociological, and literary attention since Hippocrates, and is the subject of some 8,000 articles, monographs, chapters, and books in the modern medical literature.
A robust science of the doctor–patient encounter and relationship can guide decision making in health care plans (Goold & Lipkin, 1999; Gordon & Rost, 1995; Levinson & Roter, 1993). However, physicians should focus on continuity: in their relationships with individual patients, between their patients and other clinicians and with the organization as a whole. Trust is most genuine when a relationship has a history of dependability, support, generosity, and good will. Continuity encourages trust, provides an opportunity for patients and providers to know each other as people and provides a foundation for making decisions with a specific individual. It allows physicians to be better advocates for their patients and allows patients some power by virtue of the personal relationship they have with this physician (Goold, 1996; Goold & Lipkin, 1999; Hjortdahl & Laerum, 1992; Sofaer & Hurwicz,
1993).