Are ethics and managed care strange bedfellows or a marriage made in heaven?

It is believed that, rather than making medicine less “ethical”, managed-care systems have the potential to show the moral limitations of fee-for-service physician autonomy while helping us develop more socially responsible models.

Abstract

US physicians and ethicists are having a difficult time these days working out what to make of managed care. As Howard Brody observes, people view managed care as “ethically tainted”, 1 Brody H Do gag rules in managed care contracts compromise ethics?. Fam Pract News. Jan 1,1995; 8 Google Scholar a marriage of expedience or necessity between business and medicine. Others go so far as to see it as a deal with the devil in which cost, not outcome, has become the bottom line. 2 DeBakey ME Anlyan WG Managed care puts us all at risk. Houston Chronicle. June 18, 1995; : 1C-4C Google Scholar According to this view, managed care is by its very nature evil, and physicians cannot function in such systems without sacrificing their integrity. Many physicians and ethicists view the managed-care revolution as a demise of medical morality because they equate medical ethics with the preservation of autonomy: both the patient's and the physician's. We believe that, rather than making medicine less “ethical”, managed-care systems have the potential to show us the moral limitations of fee-for-service physician autonomy while helping us develop more socially responsible models. 3 La Puma J Anticipated changes in the doctor-patient relationship in the managed care and managed competition of the Health Security Act of 1993. Arch Farm Med. 1994; 3: 665-671 Crossref PubMed Scopus (12) Google Scholar