subject: Ethical threats physicians experience since the inception of Managed Care Organizations (MCO) [print this page] Ethical threats physicians experience since the inception of Managed Care Organizations (MCO)
In evaluating some of the possible threats and advantages physicians have experience since the inception of managed care organizations (MCO), the reports are varying. However, the main purpose of [this] program was to achieve efficiency by rationing the resources used to deliver care. With this objective, can it be postulated that ethical principles are being compromised? In the last 20 years managed care has become the primary medical financial system in the United States. As of 2000, enrollment exceeded 130 million people with no signs of slowing down. With so many health care providers whose financial survival rest in the hands of this payment method, great debate about its efficacy has been raised about ethics compliance and its effects on patient care.
According to the Physicians Manual of Ethic, the physician's professional role is to make recommendations based on their medical merit and to pursue options that comport with the patient's unique background and preferences. The Manual goes on to say the physician must act as the patient's advocate. However, this could become problematic for physicians when multiple commitments arise from cost-containment pressure under the managed care regulations.
Although, physicians may make treatment recommendations, they are often secondary to profit generation. The MCOs' most powerful tool to control costs is its ability to restrict member access to care.
Medical ethics are comprised of four basic principles (1) respect for persons, (2) beneficence, (3) nonmaleficence, and (4) justice. They provide a context to understand the ethical problems posed by managed care, and to propose ways to correct these ethical shortcomings.
Managed care agencies clearly violate the first principle, respect for persons. This means patients right to autonomy; to by self governed and to exert his own free will in his best interests. However, In effect, a patient's treatment decisions have already been made by the MCO, to an extent denying the patient the right to make an educated decision.This also conflict with the physician's ability to fight for the patient in fear of penalty.
The second area which violates the patient's rights is beneficence. According to the authors, this is "defined as acting in a manner, which assures positive benefit for the patient. If patient treatment is being denied because of MCO refusal to approve the treatment because of cost or on the law of averages are clearly not acting in the best interest of the patient.
The third area is nonmaleficence. This is defined as first do no harm. Clearly the denial of treatment because of cost containment which results in further injury to the patient is causing harm. Physicians may fail to discuss a particular treatment for a patient if he knows it is not covered by the MCO. Although, not proven, further research on how many physicians fail to discuss alternative treatment in an attempt to avoid conflict with the patient or penalties from the MCO should be explored.
The final ethical principle is justice, which holds that all persons must be treated with fairness and equality. This applies to resources. Since there are "limited resources they are allocated for an entire population, which mandates treatment by a formula rather than individual consideration. Individuals that suffer from a common illness, is more likely to have his treatment covered. However, the more costly and invasive conditions are not covered. This decision is made by the MCOs and physicians have no control over it.
With every debate, there are two sides, and this one is no exception. MCOs have made healthcare available to more people than any other time in history. With the creation of the 2010 healthcare reform, it is estimated that by 2016, 90% of all Americans will have access to healthcare. This is only possible because of the MCOs ability to develop a program which controls cost, reduce fraud and contributes to research. Unfortunately, MCOs cannot be all things to everyone. However, a new system needs to be developed, which will protect the rights of patients, put healthcare back in the hands of physicians, while operating within ethical boundaries..
