Managed Care and Ethics

The following is a bookmark folder relating to the topic of ethics in healthcare. With the proliferation of managed care, mediation and ethical concerns are increasingly important issues. The following bookmarks provide an overview of consumer, physician, and organizational sites. Primarily, the WWW is filled with propaganda and consulting groups presenting info on the topic of ethics in managed care. (In fact, some of the following bookmarks can be categorized as such.) However, it is important to present all sides of the issue. And while there are diverse ethical societies located on the web, it is important to discern the intentions of each. I, therefore, admonish the user of this bookmark page to be careful and to scrutinize the sites they visit.

I have rated the sites on a five star basis. I have considered accessibility, presentation, linking ability, and, of course, relevance of material. While each site does not directly deal with managed care, per se, the ethical issues in healthcare that are definitely exacerbated in the managed care arena.

This site empowers patients and doctors who may be concerned about the level of care receiver by a provider or managed care organization. This site is easy to use, and is an excellent site. However, like most of the web sites on ethics in managed care, there is a fee to receive extra info. Unfortunately for those of us without the extra cash, it costs $125 to become a member and enjoy all of the benefits. However, non-members can still enjoy access to link and events, as well as information on patient's bill of rights.

Essentially, this is a site for patients. However, they do encourage individuals and managed care organizations to have representatives join. They offer a variety of books, videos, and literature about how patients may untangle billing issues, deal with advanced directives, and confront doctors and legal authorities about abuses in the system. They provide reviews, patient satisfaction measurements, and let consumers know whom they can complain to.

The Center for Healthcare Ethics is involved in promoting ethical behavior in managed care and other arenas of healthcare. The Center's mission is to enable ethics committees and healthcare professionals to continue their self-education and to enable healthcare professionals to act as institutional change agents for improving patient care. They offer educational publications and videos, as well as a membership, which entitles one to a quarterly review of ethical issues, a bimonthly newsletter and forum for discussion on ethical issues.

This page is interesting for a variety of reasons. First, it presents a forum for discussion and assistance in the area of managed care and healthcare ethics. They provide a good starting point for executives and individuals looking to learn more about ethics. Additionally, the links that it provides are very useful. It directs the user toward specific websites of interest. While the links are free, one must be aware that they do charge a fee for membership. This page can be a useful, as the Center's educational resources can be used for community education and for healthcare executives, physicians, and anyone interested in learning about current bioethics issues.

Right when the user visits this site you are presented with a report by the Integrated Healthcare Association questioning whether managed care requires a new set of medical ethics. Essentially, the Bioethics Consultation Group is an interdisciplinary group of professionals in ethics, medicine, law, nursing, and theology. The Group offers training and support of corporate and hospital ethics committees, clinical case review, and assistance in the development of health policy options for government and private institutions. They consult individuals, families, providers, administrators and organizations about a variety of healthcare issues, including issues focusing on managed care.

While this is another site that offers services, one can also gain unbiased information for free. This could potentially be a promising site for individuals and companies looking to address critical managed care and healthcare ethics issues. They offer literature on "Forming a Moral Community," and Managed Care Quarterly, and other clinical ethics reports.

This site comes directly of f of the American Medical Association's (AMA) Web page. The Institute for Ethics was established in 1997. Although technically part of the AMA, it functions as an independent academy at the AMA, performing research in a range of areas in biomedical ethics. The Institute publishes scholarly papers and runs educational and outreach programs.

The Ethics Institute has placed managed care as one of its four emphasized topics for research. The others are: end-of-life care, genetics, and professionalism. From this site one can hyperlink to the brief discussions on such topics as the "Principles of Medical Ethics" and "The Fundamental Elements of the Patient-Physician Relationship."

This page is just up and running, so all of the content is not yet there. However, I have strong expectations for this page and imagine that being a Member" of the AMA allows one to view much more material. Finally, the Institute staff will often work on projects with the AMA Council on Ethical and Judicial Affairs.

This site covers major ethical dilemmas of managed care. Individual users can type in and post their feelings and experiences with managed care. Consumers ask questions and professionals try to answer them. Some examples: a)Physician working group report on ethics and managed care, b) medical history discrimination, c)info on physician/patient relationship.

This specific page on ethics doesn't provide a great deal of professional opinion on each of the subjects, but it does allow people to know that they are not alone, and that there are ways to resolve ethical issues within managed care.

Other issues covered are capitation, cost cutting , a poll, healthcare and legislation, and gossip. The AMSO is the acronym for the American Medical Specialty Organization. One of the interesting components of this site is that it provides a panel of experts in the field of managed care. Experts cover a broad range of managed care and ethics topics that are very useful to the user.

The following documents relate to ethical issues in healthcare. Admittedly, I had some degree of difficulty locating good papers on the subject of ethics in the managed care arena, located on the WWW. The five attached are the best of the dozens that I looked at. For the most part, the papers existing on the WWW are generally propaganda. The following documents are a collection aimed at either physicians, consumers, healthcare executives, or managed care employees.

This paper presents a fine overview of many of the ethical dilemmas faced by providers within the managed care arena. It is any easy read, and is directed at physicians, as well as the lay-person. For example, the paper considers the ethical dilemmas for healthcare providers who must serve both as gatekeeper and patient advocate, or the physician who must now balance the needs of one patient against others, as well as the need to be cognizant of the organization’s financial stability.

The paper is directed at physicians, executives, and ivdividuals. One of the major topics covered is the ever-evolving role of physicians as mediators. To this end, it discusses different levels of mediation. Examples are provided of cases that could be faced by doctors. The paper recognizes that the ethical issues or values conflicts that it raises, will be a part of the healthcare environment for the foreseeable future.

This is an excellent overview of pertinent cases of bioethics before the Supreme Court. It covers a variety of health issues, including: The Right to Refuse treatment, Judicial Recognition of Patient's Rights to Withhold or withdraw Life Sustaining treatment, The Supreme Court's Involvement in Right to Die Cases, and The Patient Self Determination Act. The purpose of this sight is to review the major cases and trends in bioethics.

This paper is directed at lawyers, executives, and individuals looking to learn more about the present legal issues relating to ethics in health care. While the cases are not specific about managed care, each applies to patient and physician rights and ethical issues within the managed care realm.

This paper was presented by Amanda O'Connor and Laura Alcala, the Directors of Marketing and Member Services of Kaiser Permanente of Pasadena. Essentially, it describes actions taken by the company to provide an educational program for managers and physicians on how to mediate conflict. The goal of the course was to identify the dimension of conflict and its impact on managing disputes in a healthcare setting.

The paper concludes that the training had a positive effect on the mediation skills of participants. It is apparent that the audience of this paper is managed care employees. They would benefit from the course, and Kaiser would benefit from the course. While this paper does not directly deal with ethical issues, per se, it does address how the managed care organization may reduce conflict in situations involving mediation of healthcare issues. Keeping the intended audience and authors in mind, it presents the managed care organization's perspective.

This is one of four papers attached to the Columbia/HCA website. Thus, one can imagine that it would be extremely slanted toward Columbia/HCA's philosophies. However, it presents a very interesting and reasonable argument of the role of ethical physicians in making decisions about the welfare of their patients. The paper acknowledges that these individuals can be better advocates than a managed care ethics committee, because of their direct contact to the patient.

The reading is directed at physicians and patients. While it does indirectly promote Columbia/HCA its content is interesting and applicable to the topics of ethics in healthcare.

This brief paper presents a basic overview of how ethics have evolved into the medical work place. It provides an example of technology advances v. ethical advances, and asks the question, "What can we do AND what SHOULD we do in medicine?" The paper lacks any real content, but is directed at individuals who have never really considered issues of medical ethics.

JOURNALS AND NEWSLETTERS

The following is a list of potentially useful journals and newsletters located on the web. While one must subscribe to read relevant articles, there is no lack of information.