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- Title
Ethical practice in managed care: a dose of realism.
- Authors
Hall, Mark A.; Berenson, Robert A.; Hall, M A; Berenson, R A
- Abstract
This article examines the ethics of medical practice under managed care from a pragmatic perspective that gives physicians more useful guidance than do existing ethical statements. The article begins with a framework for constructing a realistic set of ethical principles, namely, that medical ethics derives from physicians' role as healers; that ethical statements are primarily aspirational, not regulatory; and that preserving patient trust is the primary objective. The following concrete ethical guidelines are presented: Financial incentives should influence physicians to maximize the health of the group of patients under their care; physicians should not enter into incentive arrangements that they are embarrassed to describe accurately to their patients; physicians should treat each patient impartially without regard to source of payment, consistent with the physician's own treatment style; if physicians depart from this ideal, they should inform their patients honestly; and it is desirable, although not mandatory, to differentiate medical treatment recommendations from insurance coverage decisions by clearly assigning authority over these different roles and by physicians advocating for recommended treatment that is not covered.
- Subjects
MEDICAL ethics; MANAGED care programs; ETHICS; HEALTH care rationing; LABOR incentives; PAY for performance; PATIENT advocacy; PHYSICIAN-patient relations; PHYSICIANS; RESOURCE allocation; SOCIAL justice; TRUST; DISCLOSURE; SOCIAL responsibility; OCCUPATIONAL roles; PASSIVE euthanasia
- Publication
Annals of Internal Medicine, 1998, Vol 128, Issue 5, p395
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-128-5-199803010-00009