Academic journal article Health and Social Work

Confidentiality and Managed Care: Ethical and Legal Concerns

Academic journal article Health and Social Work

Confidentiality and Managed Care: Ethical and Legal Concerns

Article excerpt

Before managed care, social work services in the field of mental health tended to be needs driven. Increasingly, these services are resource driven, and there is a profit motive for the managers whether the resource is the public or the private dollar. As managed care companies take over the allocation of funds, the monitoring of treatment, and the measurement of outcomes, social workers encounter an ethical and legal dilemma with the demise of confidentiality in the professional-client relationship. The dilemma appears to be rooted first in the essential difference in primary purpose between social workers and managed care companies and second in the heavy reliance of managed care companies on burgeoning information systems.

Specifically, many social workers providing services within managed care systems are concerned about the quantity of information sought about the client; the sensitive nature of that information (which if exposed leaves the client entirely vulnerable); the way in which the client is, for all intents and purposes, forced to permit the disclosure of the information to ensure third-party payments (unless able to pay directly for services); the potential use of the information to deny rather than provide needed services to the client; and the all-too-often suspect security of the information systems involved. Social workers are also uncomfortable when they consider the potential negative effect that the loss of confidentiality may have on the client-worker relationship as well as the possible liability issues that may ensue.

Given that the profession has long heralded the protection of client confidentiality, it is timely that social workers re-examine traditional guidelines within this new context of managed care. If safeguarding confidences is still valued, then social workers, individually and in consortium, need to negotiate with managed care policymakers and government regulators to develop new mechanisms to protect client information.

CLASH OF ESSENTIAL PURPOSES

Difference in Mission

Social workers need to be aware of the fundamental differences in mission between managed care personnel and themselves as providers and the effect of those differences on the treatment of client data. Because managed care companies primarily serve the funding bodies, they have an essential disparity of purpose from social workers. They are concerned with capitated risk for groups of people, and therefore any individual's particular need is evaluated in the context of all the other covered lives. Thus, managed care companies have gatekeepers in place who examine intimate details about a person from a distance and who may use that information to deny rather than provide needed services. In contrast, social workers' general aim is to work with all who request and need services. With managed care, then, the mission is restrictive and generalized, whereas with social workers service delivery is inclusive and individualized.

Difference in Reasons for Documentation

When care is managed, client data become determinative. Recordings undertaken for managed care companies are first and foremost meant to establish the saving of health care dollars for employers and insurance companies. A document containing highly confidential material, in the hands of a managed care administrator, will be used whatever way is most profitable from a business perspective. This contrasts with the traditional use of social work records, which has been to chronicle, in the context of trust, individuals' treatment and progress for the purpose of assisting recovery.

Difference in Use of Outcome Measures

An impetus for adopting a managed care format in behavioral health care is to promote the measurement of treatment outcomes. This purpose, seemingly laudable at first, belies another agenda. Marketers of managed care companies stress that health professionals will be better prepared to deliver the optimum treatment for each disorder once reams of outcome data are analyzed. …

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