Ethical Challenges in Managed Care: A Casebook

Ethical Challenges in Managed Care: A Casebook

Ethical Challenges in Managed Care: A Casebook

Ethical Challenges in Managed Care: A Casebook


Through twenty case studies that illustrate a wide range of ethical challenges, this book explores the goals, methods, & practices of managed care, & offers practical guidance for addressing the ethical & policy issues inherent in such a system.


Karen G. Gervais and Dorothy E. Vawter

Increasingly, the ethical dilemmas in health care contain unfamiliar elements. For example, financial reimbursement structures appear to play an important role in the quality of patient care, and complicated contractual arrangements among multiple health care providers and payers seem to obstruct rather than facilitate the provision of specific services and continuity of patient care. The organizations that have become the heartbeat of health system change—managed care organizations—are well aware that many of their decisions are value laden and that they lack sufficient ethical resources to guide trade-offs central to their practice, for example, the balancing of individual and population interests, cost and effectiveness, business goals and health care goals, and responsibilities to enrollees and the community. The ethical challenges arising within managed care clearly call for sustained ethical reflection and new ethical guidelines, procedures, and skills.

Since the early 1980s, the prevailing arrangement for financing and delivering health care in the United States has been undergoing a cost-driven and market‐ based transformation to managed care. "Managed care" is a generic term for the myriad organizational arrangements that integrate the financing and delivery of health care in such a way that the former constrains the latter. It combines the business of insurance with the delivery of professional health care services. Managed care organizations secure enrollees by offering the purchasers of insurance (employers and government) competitively priced enrollment premiums and providing enrollees fair access to quality health care within a finite budget.

The Cases and Commentaries

Because managed care has evolved so rapidly and is still continuing to evolve, the ethical issues it raises have yet to be completely mapped out and adequately explored. This book provides twenty detailed case studies that offer snapshots of . . .

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