Conflicts in managed care
Article Abstract:
Managed health care organizations create many levels of conflict of interest for physicians, case managers, and patients in order to reduce costs to the organization. Legislation to allow patient access to and to provide for the evaluation the case manager, and to reduce the restrictions on physicians may pressure organizations to reduce conflicts. Understanding these conflicts may assist in reducing physical risks to patients, and legal and ethical risks to physicians and providers. Managed care programs, by nature, have third parties participating in decisions traditionally made between physician and patient. Physicians are financially rewarded by prescribing treatments, referrals and tests that ultimately reduce costs for the organization. Physicians are punished if they do not. This leads to risks to the patient when the best treatment may be withheld. Physicians and medical care personnel also act as fiduciaries or trustees for their patients health, but their obligation to the patient is compromised by the obligation to the managed care organization. Patients are in conflict because the choices presented to them are limited by physicians whose obligation to disclose treatment options are curtailed by their organization. Finally, case managers, who are direct employees of the organization and authorize care, are unreachable by the patient.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1995
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Pharmaceutical promotions - a free lunch?
Article Abstract:
A task force of physicians was set up to look at drug fairs held by pharmaceutical companies at scientific meetings. Task force members agreed that chief residents or residency-program directors should review marketing materials from pharmaceutical companies before they are distributed. Pharmaceutical companies often give gifts to physicians such as food, alcohol, pocket protectors and pens. Pharmaceutical companies also sponsor scientific meetings or continuing medical education for physicians. The rationale is that physicians will not attend meetings or continuing education classes if they have to pay for them themselves. Physicians are compromising their values by accepting promotional materials from pharmaceutical companies. Patients end up paying for these gifts with increasing drug costs and rising insurance premiums.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1992
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