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Given the moral nature of medical practice, the over-emphasis on business processes raises ethical questions (Mains, Coustasse & Lykens, 2004). The goals of Managed Care Organizations (MCOs) focus on meeting business objectives. Some of the objectives hinge on interfering with the ordinary doctor-patient relationship that has been dominant in clinical practice. It is necessary that despite the need to achieve the goals of MCOs, the moral nature of clinical practice does not get lost. The MCOs need to strike a balance between business objectives, as well as ethical issues of clinical practice.
The authors seek to outline the ethical questions that arise as a result of incentives that MCOs provide to the physicians in their network. Given the need to obtain the promised incentives, physicians engage in cost cutting measures. As such, this grants the MCOs a sizeable control of clinical practice (Mains et al., 2004). The MCOs do not disclose the incentives provided to the involved parties. The physicians, for whom MCOs target the incentives, do not seem to understand the incentives since there are variations in each clinical case. According to the authors, the intention of physician incentives is good but due to implementation issues there are ethical considerations that arise. The application of incentives has a significant bearing on the process of clinical decision-making. Brody (2012) argues that MCOs have increased the number of factors that a physician has to consider when making clinical decisions. The physician has to factor in new competing demands, such as resource availability, when making clinical care decisions. Traditionally, some of the new requirements did not have a role in the determination of the care provided. Other ethical issues relate to the fact that it is necessary under both economic and legal terms to disclose the incentives offered. MCOs regard the incentives as proprietary and as such decline to agree to the disclosure of the incentive schemes applied (Rosenbaum & Lamas, 2012).
MCOs create a clinical environment that makes the physician perform a dual function by adding financial advocacy on top of the traditional role of taking care of patients. Principles of clinical practice require that the doctor represent the needs of the patient. On the other hand, MCOs create an environment where cost effectiveness in managing patients plays the central role (Rosenbaum & Lamas, 2012). The physician is thus expected to do what is best for the patient while at the same time ensuring attainment of the institutional goal of minimizing the resources. Physicians have to continue viewing patients as individuals as well as think of the patients as a pool of persons as directed by MCO objectives. According to Mains et al. (2004), the physician’s role in such circumstance then follows the utilitarian model of doing good for the majority patients rather than for an individual patient.
The environment of managed care has a significant effect on the physician-patient relationship that for a long time has defined clinical practice. The emphasis on cost effectiveness as well as the focus of doing good for all may alienate physicians from the moral obligation on patient needs. Physicians have always treated individual patients as per the clinical needs presented. The entry of the MCOs may cause the physician to focus on the bigger picture rather than the patient seated right across his desk. In such situations, patients may be provided with substandard care without their consent as a result of the physician’s consideration of related care costs (Rosenbaum & Lamas, 2012). In the long run, physicians my neglect traditional principles of clinical practice under the guise that the system demanded them to act in such manner. If such an eventuality occurs, it will lead to the death of traditional clinical practice. Reviving such a system would be next to impossible leaving the control of clinical practice entirely in the hands of MCOs.
References
Mains, D.A, Coustasse, A., & Lykens, K. (2004). Physician Incentives: Managed care and ethics. The Internet Journal of Law, Healthcare and Ethics, 2(1). Web.
Brody, H. (2012). From an ethics of rationing to an ethics of waste avoidance, New England Journal of Medicine, 366,1949-1951.
Rosenbaum , L. & Lamas , D. (2012). Cents and Sensitivity: Teaching physicians to think about costs. New England Journal of Medicine 367 (2), 99-101.
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