No Margin, No Mission: Health-Care Organizations and the Quest for Ethical Excellence

No Margin, No Mission: Health-Care Organizations and the Quest for Ethical Excellence

No Margin, No Mission: Health-Care Organizations and the Quest for Ethical Excellence

No Margin, No Mission: Health-Care Organizations and the Quest for Ethical Excellence

Synopsis

Can the ethical mission of health care survive among organisations competing for survival in the marketplace? On this question hinges not only the future of health care in the US, but that of the health care systems of all advanced countries. This book presents both an analytic framework and a menu of pragmatic answers. How can health plans determine medical necessity in a way that ensures quality care, controls costs, and builds trust with patients and physicians? What are the strategies for caring for vulnerable populations that meet their special needs without dramatically increasing costs? To answer these and other similar questions the authors blend ethical analysis with real-world examples. The outcome is a rich analysis of the ethical challenges facing health care organisations, combined with tangible examples of exemplary methods to address these challenges.

Excerpt

Our goal in this book is to weave ethical analysis and real-world experience together with a strong, practical, intellectual thread. And, like the golden thread that allowed Theseus to find his way out of the dark, twisting labyrinth of the Minotaur, we hope this book will provide a pathway to valuable lessons for those bold enough to venture into the den of the United States’s brand of managed care. If readers emerge refreshed, emboldened, and equipped with new ideas in their own quest for ethical excellence in health care, then this book will have fulfilled its purpose.

But it is reasonable to ask: Why venture in at all? Isn’t managed care a failed idea, one encumbered with all the ignominious trappings of capitalist markets run amok? Nations with universal health insurance should find nothing of interest here. Isn’t the lesson to be learned from managed care the sad fact that competitive markets place such stress on health-care organizations that ethical excellence is one of the first casualties?

We hope to draw readers toward different conclusions. It is true that the hopes of the last decade for a reborn U.S. health care system lie in disarray. Conflict and stagnation seem the heirs of a once buoyant vision. Yet, even if managed care in the United States is “dead,” as some claim, its great challenges—and great opportunities—still face us.

Rising health-care costs still afflict the United States, as they do all other advanced nations. New technologies and aging populations drive the desire for health-

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