Ethical issues in managed care

Article Abstract:

Physicians in managed care settings must strive to maintain the integrity of the physician-patient relationship and the quality of patient care. In 1994, the American Medical Association's Council on Ethical and Judicial Affairs issued a report that addressed ethical issues in managed care. That council recognized that physicians who practice in managed care settings may be torn by conflicting loyalties. Medical care that is best for one patient may conflict with the needs of other patients or the organization's need to control costs. In addition, managed care companies may offer financial incentives to encourage physicians to limit use of services. In these cases, physicians should owe their allegiance to their patients' welfare. Physicians must act as patient advocates by lobbying for medical care that would materially benefit their patients and refraining from 'bedside rationing.' Financial incentives must be fully disclosed to patients and should be based on quality not quantity of care.

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Professional boundaries in the physician-patient relationship

Article Abstract:

Violations in professional behavior between physician and patient can be best prevented through education. Professional conduct and respect for patients should be taught to medical students. Students who display sexually aggressive behavior should be directed to other kinds of work. Sexual misconduct occurs most often between a male doctor and female patient, and is likely to happen when no one else is around. An attendant should be present for pelvic exams, with patients who have been sexually abused, with patients who suffer from severe anxiety, and with patients whose behavior concerns the physician. Gifts and services given between patient and physician can cause problems. Physical contact not part of the medical exam may be inappropriate.

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Stroke patients, "managed care," and distributive justice

Article Abstract:

Physicians need to be active participants in the federal government's plan to move Medicare beneficiaries into managed care. A 1997 study found that elderly stroke patients enrolled in a managed care program were less likely to be treated in a rehabilitation facility than Medicare patients. This is a serious problem, since studies have shown that patients treated in these facilities are three times more likely to be effectively rehabilitated than those treated in a skilled nursing facility.

Editorial, Political activity, Physicians, Medical professions, Stroke patients

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