Medicine and the Marketplace

Kenman L. Wong

Description

The emerging dominance of managed care provided by profit-seeking corporations has intensified the public's concern that traditional business goals of maximizing profits will destroy medicine's traditional commitment to patient well-being. Society is left to wonder how physicians can properly honor their duties to patients when the managed care organizations that employ them have financial obligations to shareholders.

Kenman L. Wong's timely book addresses issues raised by the new intersections of business and medicine with an ethical assessment of emerging health care arrangements. By focusing on organizational ethics, he offers an integrative framework that seeks to balance patient, societal, and corporate interests. To avoid overly simplistic solutions, Wong compares managed care, traditional fee-for-service arrangements, and other proposed health care reform options such as rationing programs and medical savings accounts based upon principles of fairness.

Though Wong argues that managed care is the best available option, he finds fault with many current practices of managed care organizations. He evaluates the place of the profit motive in the guiding ethos of managed care organizations and addresses the pressing issue of whether or not managed care should remain the exclusive domain of nonprofit organizations. He concludes with an integration of business ethics and medical values that formulates organizational norms and specific practice reforms for managed care organizations.

Medicine and the Marketplace should be read by health care practitioners, plan administrators, instructors of medical ethics, health administration, and public policy, and members of the general public interested in how managed care can be made into an ethics-driven system.

Sujets

• Health Policy
• Medical
• Médecine
• Nursing
• Health care system
• Ethics
• Administration

Informations

• Publié par: University of Notre Dame Press
• Date de parution: 04 janvier 2000
• Nombre de lectures: 0
• EAN13: 9780268086664
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Medicine and the Marketplace The Moral Dimensions of Managed Care KENMAN L. WONG

MEDîCînE anD thE MarkEtPlaCE

Medicine and the marketplace The Moral Dimensions of Managed Care

KENMAN L WONG

UîvérsîTY ôf Nô T r é Damé Préss

otrÉ ĀmÉ ïïĀĀ

Uîverŝîty Of NOtre Dae Preŝŝ NOtre Dae, IN 46556 www.undpress.nd.edu

A Rîghtŝ Reŝerved

COyrîght1998 y Uîverŝîty Of NOtre Dae

Maûàçtûred ï te uïted StateŚ ôFAerïça 4 paeraçk 2000 iSBn 0-28-03 -

Lîrary Of cOGreŝŚ cataôGïg-ï-PûïçatïO Data

WOg, Kea l., 1964 medîçîe ad the arketaçe : the Ora dïeŝïOŝ Of aaged çare i Kea l. WOg.  ç. IçÛdeŝ îîOgrahîça reereçeŝ a îdex ISbN 6844X (ak. aer) —฀ISBN-13:฀฀978-0-268-08666-4฀(web฀pdf) î maaged çare aŝ (medîça çare )mOra a ethïça aŝeçtŝ  Medîça çaremOra ad ethîça aŝeçtŝ . Heath çare ratîOîgMOra ad ethîça aŝeçtŝ. 4. medîça ethïçŝstadardŝ. ! Tîte. RA4.W67 1999 6.'458dç1 986

The aer Ûŝed î thîŝ ûîçatîO eetŝ the îîÛ reqÛîreetŝ O the Aerîça NatîOa stadard or IoratïO sçîeçeŝPeraeçe Of Paer or Prîted lîrary materîaŝ, ANsI Z9.481984.

CôTéTs

Peàce vîî Intôductîôn Ltàtôns ôf te cÛent Debàte 3 Exànng te Debàte  Busîness and Medîcîne at a New Côssôads  BàçkgôÛn àn hstôy ïï New Etçàl càllenges  Pôîts vs Pàtents R8 Meçne àn te Màketlàçe: an uneàsy Tensôn 0 Te cÛent Legàl Envônent 3 2Reraîng the Debate: Pespectïves Cïtîcal ôf Managed Cae29 Te Môàl Tyôlôgy 30 Pàtent-centee PÛsts 3  Màket Reo PÛsts 3 7 Exlçt Ràtônes  3Pespectîves în SuppôtReraîng the Debate: ôf Managed Cae47 agÛents n côôn 7 Fô-Pôît Mànàge càe càôns 0 Nôn-Pôît OgànZàtÔn SÛôtes  càÛtôÛs SÛôtes ôf Mànàge càe 7 4Fee-o-Sevîce Medîcîne6 6 Te BÛsness Etç agÛent  6 Te Meçàl Etç agÛent  Individual Physicians and Altruism66 Organized Medicine and the PatientCentered Ethic

68

Te QÛàlty agÛent 7 1 Ote cônçens 74 cônçlÛsôn 7 7 5 Altenatîve Reo Pôpôsals an Etçàl ctqÛe ôf te agÛents ôf Màket Reo PÛsts 81 an Etçàl ctqÛe ôf te agÛents ôf Exlçt Ràtônes 87 a Geneàl càse o te Môàty ôf Mànàge càe 93 6the Nôn-PôitThe Ethîçal Ipôtançe ôf Dîstînçtîôn97 Nôn-Pôîts àn Meçne as à ÇôÛnty Gôô 99 Deençes n aççôÛntàblty 103 Deençes n Môtves 105 Deençes n Beàvô 107 Nôn-Pôîts àn te Inteests ôf te Pôô 11 7Fô-Pôit Oganîzatîônsy ôf The Môal Vîabîlît 5 an Etçàl ctqÛe ôf te agÛents ôf FôPôît Mànàge Çàe càôns 11 a càse o càÛtôÛs SÛôt ôf Mànàge càe 11 Busîness Ethîçs o Managed Cae Oganîzatîôns25 Reàssessng te Deençes between BÛsness àn Meçne 1 côntbÛtôns rô BÛsness Etçs 130 Çàllenges tô te alçàtôn ôf à BÛsness Môel tô Meçne 133 avàntàges ôf àn Enlgtene BÛsness Môel ôve à Tàtônàl Meçàl Môel 139 9Stakehôlde Respônsîbîlîtîes în the New Health Cae Envîônent43 Ogànzàtônàl Resônsbtes 143 ÇôÛnty/Gôvenentàl Resônsbltes 149 Elôye Resôns bl tes 1 Pàtent Resônsbltes 1 cônçlÛsôn 1

Nôtes

57

Seleçted Bîblîôgaphy

Index

vi

23

Çèŝ

95

Préàçé

hîs book îs an outComE of thE PrEssîng nEED Or EthîCal rEECtîon on thE Changîng naturE of thE AmErîCan hEalth CarE systEm, Par­ tîCularly thE rolE anD rEsPonsîbîlîtîEs of largE-sCalE organîzatîons ÈaCh of thE sîgnîïCant stakEholDErs în mEDîCînE, înCluDîng hEalth CarE ProÉssîonals, PatîEnts, hEalth Plan aDmînîstrators, însuranCE ComPanîEs, anD thE broaDEr soCîEty, îs àCED Wîth nEW anD Com­ PlEx moral ChallEngEs hîlE muCh OCus has bEEn gîvEn to thE DîlEmmas that PhysîCîans arE àCîng at thE bEDsîDE, thErE has bEEn a laCk of substantîvE înquîry înto thE EthîCs of thE organîzatîons WhosE PraCtîCEs anD PolîCîEs ContrîbutE to thE quanDarîEs hEalth CarE ProvîDErs àCE hE goal of thîs book îs to shED lîght on thEsE îmPortant toPîCs by Examînîng a numbEr of îmPortant quEstîons, înCluDîng thE Ol­ loWîng  Çan organîzatîons EngagED în thE task of Proït-makîng ProPErly honor thE întErEsts of PatîEnts? îll PhysîCîans unDEr ContraCt to managED CarE Plans bE àCED Wîth DîvîDED loyaltîEs , lEaDîng t o harm t o PatîEnts? ŚhoulD thE Proït motîvE Play any rolE în mEDîCînE? hEsE arE CrîtîCal quEstîons Or WhîCh àCîlE ansWErs Wîll not sufïCE As thE rEaDEr Wîll sEE,  am not ConvînCED that thE solutîon to thE DîlEmmas arîsîng at thE nEW întErsECtîons of busînEss anD mEDîCînE îs to J Ettîson managED CarE outrîght ŚuCh ProPosals arE muCh too sîmPlE ManagED CarE îs not întrînsîCally Evîl oWEvEr, thE PolîCîEs usED to DEtErmînE thE Way CarE îs DElîvErED havE thE PotEntîal to CausE grEat harm hus, thE EthîCal valuEs bEhînD Pol­ îCy anD ProCEDurE sEttîng must bE rîgorously ExamînED anD rEOr­ mulatED îf thEsE nEW hEalth CarE arrangEmEnts arE to guarD thE întErEsts of PatîEnts anD ProvîDErs n thE OlloWîng PagEs ,  Wîll

OCus on thEsE îssuEs anD DEEloP îDEas so that managED CarE Can bEComE an EthîCsDrîEn systEm hE ComPlEtîon of a Proj ECt of thîs naturE rEquîrEs thE Work of many hanDs  am DEEPly înDEbtED to a numbEr of PEoPlE Who haE maDE substantîE întEllECtual Contrîbutîons to thîs book îllîam  May, ohn  ÇrosslEy, anD an  Mîtro of thE ÙnîEr­ sîty of ŚouthErn ÇalîOrnîa anD ŚCott  aE of thE albot ŚChool of hEology DEsEr E PartîCular mEntîon as sCholars Who gaE însîght­ Ul guîDanCE anD EDîtorîal suggEstîons on EarlîEr Ersîons of thîs manusCrîPt  am also înDEbtED to a numbEr of hEalth CarE ProÉs­ sîonals n thE Ormal sEttîngs în WhîCh  haE PrEsEntED îDEas om thîs book, anD în PErsonal EnCountErs , thEy haE ProîDED PrîCE­ lEss ïrsthanD însîghts înto thE Changîng naturE of mEDîCînE  am also aPPrECîatîE of thE Eorts of sta mEmbErs at thE Ùnî­ Ersîty of otrE amE rEss, în PartîCular, îrECtor amEs angOrD anD ÈDîtor EbECCa EoEr îm ClEarly saW thE îsîon bEhînD thîs Proj ECt anD oErED însîghtUl EDîtorîal guîDanCE along thE Way Çallîng EbECCa's EDîtîng Work rEmarkablE îs a grEat unDErstatE­ mEnt Er EyE Or DEtaîls anD suggEstîons Or ChangEs on thE manu­ sCrîPt haE truly bEEn înaluablE n aDDîtîon to întEllECtual ChallEngEs, Wrîtîng Can bE a lonEly task GooD rElatîonshîPs arE nECEssary to rEDuCE thE sEnsE of îso­ latîon that îs oftEn thE by-ProDuCt of solîtary Das sPEnt în ont of a ComPutEr sCrEEn  am Ery thankUl to DEDîCatED îEnDs, àmîly mEmbErs, anD CollEaguEs  Past anD PrEsEnt) Who haE hElPED to ProîDE a sEnsE of Communîty" Durîng thE CoursE of thîs Proj ECt înally, anD most îmPortantly,  am EsPECîally aPPrECîatîE of thE Eorts of my WîfE, Marîka n aDDîtîon to hEr suPErb EDîtorîal Work on EarlîEr Ersîons of thE manusCrîPt, hEr CouragE, PatîEnCE, anD loE haE bEEn of hEroîC ProPortîons Durîng thE tîmE  haE DEotED to thîs Proj ECt EsPîtE a hîghly DEmanDîng sChEDulE, shE has ConsîstEntly OunD thE strEngth to bE an attEntîE lîstEnEr anD sourCE of WîsDom anD EnCouragEmEnt Ôn many Days WhEn  Élt oErWhElmED by thîs EnDEaor, shE gEntly rEmînDED mE of thE grEatEr PurPosEs to WhîCh WE arE Workîng togEthEr t îs to hEr, anD our nEWborn son, Çallan, that thîs Work îs gratEUlly DEDî­ CatED

viii

Prècè

InÔducÔn

ECEnt hEaDlînEs havE raîsED sîgnîïCant lEvEls of PublîC ConCErn ovEr thE EmErgîng DomînanCE of managED hEalth CarE, PartîCularly WhEn ît îs DElîvErED by Cor Poratîons EngagED în thE quEst Or ïnanCîal gaîns Or sharEholDEĖs  A numbEr of rEallîÉ CasEs havE hîghlîghtED thE EthîCal DîlEmmas WhîCh Can arîsE WhEn thE Proït motîvE of busînEss îs mîxED Wîth thE hEalîng mîssîon of mEDîCînE atîEnts allEgEDly havE bEEn harmED or PlaCED at sErîous rîsk as a DîrECt rEsult of varîous CostCuttîng PraCtîCEs aDoPtED to îmProvE thE bottom lînE Ś EvEral obsErvErs Poînt out that vExîng moral DîlEmmas Pîttîng Proït agaînst PatîEnt întErEsts arE înEvîtablE sînCE managED CarE organîzatîons arE, by thEîr vEry naturE, PlaCED în a moral bînD hEsE înstîtutîons havE ConîCtîng rolEs în thEîr attEmPt to UnC­ tîon both as traDîtîonal busînEssEs, WhîCh havE ïnanCîal oblîga­ tîons to sharEholDErs, anD as mEDîCal EntîtîEs, WhîCh havE DutîEs to uPholD thE bEst întErEsts of PatîEnts  hEn thEsE tWo oblîgatîons ConîCt, thE Éar îs that PECunîary întErEsts Wîll PrEvaîl, harmîng PatîEnts anD EroDîng thE moral substanCE of mEDîCînE în thE ProCEss or înstanCE, onnîE rîstoW, OrmEr PrEsîDEnt of thE AmErîCan MEDîCal AssoCîatîon, statED în an întErvîEW:

E noW havE hEalth CarE bEîng ControllED by MA^s rathEr thaò by PhysîCîans CommîttED to thE îPPoCratîC Ôath    onCE hEalth CarE bEComEs CorPoratîzED    thEn îts maJor Commît­ mEnt îs to all ŚtrEEt anD thE stoCkholDErs to maxîmîzE Proïts, rathEr than to gîvE thE bEst PossîblE PatîEnt CarE usînEss Prîn­ CîPlEs arE întroDuCED that unOrtunatEly Put PatîEnt CarE sEC­ onD to CorPoratE Proïts 3