Managed Care and the Ethics of Regulation

Abstract

The dramatic appearance of managed care organizations (MCOs) on the U.S. health scene has generated tremendous anxiety among health care providers and patients. These fears are based on the belief that managed care techniques pose greater risks of under treatment than do fee-for-service modes of payment. In addition, many physicians and patients resent the limits placed on clinical autonomy by the MCO model and the stresses that it places on the traditional physician-patient relationship. These misgivings have been exacerbated by the mostly negative response to MCOs in the media and academia. Legislatures have responded to these claims and public fears with a wave of regulatory initiatives. Some of these regulations are attempts to protect patients. Others, however, are motivated primarily by antipathy toward the concept of managed care itself. This essay is an attempt to develop a social ethic of regulation and argues that the sole reason that private enterprise may be justifiably limited is when it presents a risk of harm to others or society. While some regulation and proposed regulation of MCOs meet this standard, much legislation represents an unjustified attempt to limit or handicap otherwise legal behavior merely because a segment of the population and medical profession find it aesthetically unpleasing and oppose its approach to the delivery of health services.

Current Issues in the Physician–Patient Relationship

“…18 -20 Since the inception of the third-party payer system, there have been concerns that added structural complexity created a barrier in the relationship between the doctor and patient, but the truth of this has not been broadly validated. [21][22][23][24] The goals of optimal outcomes, low cost, and improved technologies exist in both worlds. 21 It is clear that corporatization of medicine will persist, but this does not have to mandate the quality of the personal relationship that we have with our patients.…”

Social regulation of healthcare organizations in the United States: developing a framework for evaluation

“…The regulation of managed care organizations has developed rapidly over the past decade, in part because of widespread public and legislative concern about performance and the quality of care (Altman et al, 1999;De Ville, 1999;Miller, 1997). Current arrangements are administratively complex and vary widely from state to state (Fuchs, 1997), and little is known about what impact these regulatory arrangements have had on managed care organizations (Silberman and James, 2000).…”

Critical Analysis of a Public Policy: An Occupational Therapist’s Experience With the Patient Bill of Rights

“…Underlying this dissatisfaction were concerns that certain American values, such as self-determination, the right to choose, freedom of speech, and the right for justice were being impeded by the managed care organizations (De Ville, 1999;Misocky, 1998). Overall, Americans perceived lack of control in their ability to choose their plans, see specialists, and to be informed clearly and honestly about health care options because of gag regulations.…”

“…Since 1994 there have been various state legislative bills and a trend of several unsuccessful federal legislative attempts to address these concerns. The state piecemeal attempts at legislation have generally focused on access, quality of care, due process protections for patients and physicians, provisions for participation in managed care organizations, expanded patient liability, and better access to medical information for patients (De Ville, 1999;Regan, 1997;Waxman, & Dallek, 1998). An analysis of why the federal attempts have been unsuccessful is beyond the scope of this paper.…”