The Ethics of Managed Care: Professional Integrity and Patient Rights

1. Front Matter

   Pages i-xii

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2. Rationing Health Care: Inherent Conflicts Within the Concept of Justice

   • Edmund D. Pellegrino

   Pages 1-18

3. Ethical Dilemmas in Managed Care for the Practitioner

   • Eugene V. Boisaubin

   Pages 19-28

4. Managed Care and the Practice of the Professions

   • Christopher Tollefsen

   Pages 29-40

5. The Ama’s Position on the Ethics of Managed Care

   • Baruch A. Brody

   Pages 41-53

6. Medicine and Managed Care, Morals and Markets

   • Robert M. Sade

   Pages 55-73

7. A Radical Challenge to the Traditional Conception of Medicine: On the Need to Move Beyond Economic Factors When Considering the Ethics of Managed Care

   • George Khushf

   Pages 75-91

8. Managed Care and the Deprofessionalization of Medicine

   • H. Tristram Engelhardt Jr.

   Pages 93-107

9. The Ethics and Empirics of Trust

   • Mark A. Hall

   Pages 109-126

10. Ethics of Managed Care: In Search of Grounding

    • Mary Ann G. Cutter

    Pages 127-138

11. Back to the Future: From Managed Care to Patient-Managed Care

    • E. Haavi Morreim

    Pages 139-162

12. Care and Managed Care: Pyschological Factors Relevant to Healthcare and Its Delivery

    • David R. Fleisher

    Pages 163-173

13. Back Matter

    Pages 175-185

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in the culture of medicine, and they saw their mission as a generation of profit for stockholders, not necessarily medical care for clients. Cost-effective medicine was the goal in the context of a profit-making enterprise. Although preventive health care programs were promised, very few were realized and they were not nearly comprehensive. The definition of unnecessary testing slowly expanded to mean virtually any high-cost test requiring the service of a medical specialist, and low­ priced generalist physicians with limited diagnostic and therapeutic skills were made available to patients with the instruction they should limit their access to high-cost specialists. Managed care organizations tended to re ward primary care physicians who avoided specialty referrals, and severed contracts with those who persisted in sending their patients to outside consultants. Most notoriously, managed care organizations maintained veto authority over the provision of complex and expensive care, and that veto was often wielded in defiance of a physician's recommendation by managed care employees without medical training or experience. Managed care did indeed slow the rate in increase of medical costs, but not without limitations on the care provided to patients and the professional integrity of physicians. Managed care organizations were so successful that they could provide extremely high salaries to their executives even in the context of limiting cost and care. It is these developments that the papers of this symposium addressed. The most fundamental ethical issue is posed in the first paper by Dr.

• Ethical Dilemma
• ethics
• health
• issue
• knowledge
• morality

• University of Missouri-Columbia, USA

  William B. Bondeson

• School of Medicine, University of Missouri-Columbia, USA

  James W. Jones

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