Conflicts of Interest and Management in Managed Care

Abstract

The bioethics literature on managed care has devoted significant attention to a broad range of conflicts that managed care is perceived to have introduced into the practice of medicine. In the first part of this paper we discuss three kinds of conflict of interest: conflicts of economic incentives, conflicts with patient and physician autonomy, and conflicts with the fiduciary character of the physician–patient relationship. We argue that the conflicts are either not as serious as they are often alleged to be or not unique to managed care. In part two we argue that managed care represents a new paradigm for medical care that features a new concept of management. We discuss three types or levels of management that managed care highlights, namely, administrative, clinical, and resource, which together offer a more sophisticated vantage point from which to assess patient care. We do not endorse managed care, but attempt to highlight some of the positive changes brought by managed care that were difficult to attain under traditional reimbursement systems.

Influences on Physicians’ Participation in Coordinated Ambulatory Cardiology Care: A Mixed-Methods Study

“…For some physicians, this constellation led to a fear of misuse of the contractual relationship in terms of interference in their own professional autonomy. Similar aspects have already been looked into in past research [29] and are comprehensible insofar as the cardiology programme involves a lot of requirements and regulations for participating physicians. It is important to ensure a beneficial behaviour of contractual partners and keep up mutual trust.…”

Medicine and Managed Care, Morals and Markets

“…(Winslow and McGinley, 2001) The transiently successful attempts by managed care organizations to contain health care costs have taken a toll on physicians, largely through tensions produced by conflicts of interest. (Agich and Forster, 2000) A widespread sense of loss of autonomy and authority has resulted from the controls on resource utilization imposed by managed care. Some of the most effective controls have been financial incentives to physicians to reduce their recommendations of expensive care.…”