Ethical Challenges In Managed Care / Edition 1

by Karen G. Gervais, Reinhard Priester, Kimberly Otte, Mary Solberg

Overview

The rapid rise of managed care in the United States has introduced new complexities into ethical dilemmas in health care by changing the traditional relationships among health plans, payers, providers, and patients. Through twenty case studies that provide snapshots of a wide range of ethical challenges, this book explores the goals, methods, and practices of managed care.

Accompanying each case are questions for consideration and a pair of commentaries by prominent contributors from diverse fields. Through the cases and commentaries, this book clarifies the internal workings of managed care, explains relevant concepts, and offers practical, constructive guidance in addressing the ethical and policy issues.

The cases address a broad spectrum of issues concerning rationing shared resources, financial incentives, quality of care, and responsibilities to patients, vulnerable populations, and the community. Specific topics range from coverage of emergency services through funding medical education to respecting patients' religious beliefs and caring for the seriously mentally ill.

This casebook offers a wealth of insights into critical issues that affect the delivery of managed care in an increasingly competitive market. It will be invaluable for those managing the delivery and financing of health care and for students and practitioners of the health professions and health administration, as well as interested recipients of managed care.

Product Details

ISBN-13:	9780878407194
Publisher:	Georgetown University Press
Publication date:	12/01/1998
Edition description:	New Edition
Pages:	388
Product dimensions:	6.00(w) x 9.00(h) x 0.86(d)
Lexile:	1420L (what's this?)

About the Author

Karen G. Gervais is director of the Minnesota Center for Health Care Ethics in Minneapolis, Minnesota.

Reinhard Priester is a health policy consultant and associate for health policy at the Minnesota Center for Health Care Ethics.

Dorothy E. Vawter is associate director of the Minnesota Center for Health Care Ethics.

Kimberly K. Otte is an attorney in the Legal and Public Affairs Departments of Allina Health System in Minneapolis.

Mary M. Solberg is an assistant professor of religion at Gustavus Adolphus College, St. Peter, Minnesota, and a center associate at the Minnesota Center for Health Care Ethics.

What People are Saying About This

From the Publisher

"One of the most interesting areas of the current managed care debate is one that receives far too little attention: that is the ethical dimension. This book has gone a long way to fill this gap, especially when it comes to help clarify lines of responsibility and accountability. This is an important and powerful book." -- U.S. Senator Paul Wellstone

U.S. Senator Paul Wellstone

One of the most interesting areas of the current managed care debate is one that receives far too little attention: that is the ethical dimension. This book has gone a long way to fill this gap, especially when it comes to help clarify lines of responsibility and accountability. This is an important and powerful book.

Editorial Reviews

A timely and welcome attempt to identify important, if not uncommon, predicaments in managed care.

Bioethics Forum

Reviewer: Susan S. Braithwaite, MD (Luther Midelfort Mayo Health Systems)
Description: The book is a collection of twenty cases that demonstrate recurring ethical challenges derived from managed care. Commentaries by authorities in the fields of ethics, medicine, and healthcare management follow each case.
Purpose: The purpose is to clarify the internal workings of managed care and provide conceptual and practical guidance in addressing ethical issues.
Audience: The audience includes clinicians, administrators, others involved in managed care, and students in professional, preprofessional, and continuing education.
Features: The book is divided into sections on rationing shared resources, incentives to contain costs and improve quality, quality care in a competitive market, responsibilities to patients, managed care for vulnerable populations, and responsibilities to the community.
Assessment: The editors posit that managed care, in efforts to balance cost and quality concerns in ethically justified ways, is a defensible healthcare system. However, in the section on quality care they fail to adequately represent the leadership role that managed care has played in the development of standards and measures of quality, including assessment of patient satisfaction. As in other discussions of managed care, the editors here underscore ways in which interests of the individual patient conflict with the interests of the larger covered population and describe impediments to the doctor-patient relationship. Highlights of the book include exploration of patient requests for investigational interventions for life threatening conditions and the lack of incentive to managed care organizations to support public health activities or medical education. The reader is likely to conclude that some constraint of present-day practices is necessary. Although the editors provide very few answers on where that constraint should come from, their examples suggest that for some dilemmas corrective self-regulation is possible, as agreed upon by patients, communities, managed care organizations, and the employers and providers with whom they contract.

Doody's Review Service

"A timely and welcome attempt to identify important, if not uncommon, predicaments in managed care." -- Bioethics Forum

From the Publisher

3 Stars from Doody

The book is a collection of twenty cases that demonstrate recurring ethical challenges derived from managed care. Commentaries by authorities in the fields of ethics, medicine, and healthcare management follow each case. The purpose is to clarify the internal workings of managed care and provide conceptual and practical guidance in addressing ethical issues. The audience includes clinicians, administrators, others involved in managed care, and students in professional, preprofessional, and continuing education. The book is divided into sections on rationing shared resources, incentives to contain costs and improve quality, quality care in a competitive market, responsibilities to patients, managed care for vulnerable populations, and responsibilities to the community. The editors posit that managed care, in efforts to balance cost and quality concerns in ethically justified ways, is a defensible healthcare system. However, in the section on quality care they fail to adequately represent the leadership role that managed care has played in the development of standards and measures of quality, including assessment of patient satisfaction. As in other discussions of managed care, the editors here underscore ways in which interests of the individual patient conflict with the interests of the larger covered population and describe impediments to the doctor-patient relationship. Highlights of the book include exploration of patient requests for investigational interventions for life threatening conditions and the lack of incentive to managed care organizations to support public health activities or medical education. The reader is likely to conclude that some constraint of present-daypractices is necessary. Although the editors provide very few answers on where that constraint should come from, their examples suggest that for some dilemmas corrective self-regulation is possible, as agreed upon by patients, communities, managed care organizations, and the employers and providers with whom they contract.

Susan S. Braithwaite

Twenty case studies provide snapshots of a wide range of ethical challenges and explore the goals, methods, and practices of managed care. Accompanying each case are questions for consideration and a pair of commentaries by contributors from diverse fields. Cases and commentaries clarify the internal workings of managed care, explain relevant concepts, and offer guidance in addressing ethical and policy issues. Subjects range from emergency services to funding medical education. For students, practitioners, and administrators. Annotation c. by Book News, Inc., Portland, Or.

Booknews