Ethics, law, and managed care:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1997
|
| Schriftenreihe: | Ophthalmology clinics of North America
10,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV S., S. 151 - 301 graph. Darst. |
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Datensatz im Suchindex
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| adam_text | ETHICS, LAW, AND MANAGED CARE
CONTENTS
Preface xiii
Understanding Medicine s Social Contract 151
Norton Spritz
This article examines the connections between the patient, the physician,
law, and the ideals of medical ethics. How does managed care affect the
basic patient/physician understanding? Does the moral responsibility of
physicians to be the advocates of their patients outweigh the stress placed on
market forces by the managed care organizations? The survival of medicine s
fundamental principles will require strong support from physicians and the
society in which they operate.
Advocates or Adversaries: Is Managed Care Changing the Physician
Patient Relationship? 155
Steven Z. Pantilat and Bernard Lo
Managed care challenges the physician patient relationship in new ways.
Traditional fee for service medicine presented its own challenges, including
conflicts of interest and soaring heath care costs. The attempts by managed
care organizations to control costs through financial incentives, utilization
review, guidelines, profiling, and restricted formularies and devices while
maintaining quality of care lead to changes that will be noticeable to physi¬
cians. Shorter physician visits, limited choice of physician, and the potential
for unequal treatment will be noticeable to patients and may undermine
their trust in physicians. Physicians can respond to the challenges brought
by managed care and thereby minimize conflicts of interest, engender trust,
and maintain quality care.
The Ethics of Managed Care 165
George L. Spaeth
Competition among health care practitioners has always existed. In most
instances the competition has centered on the basis of providing the best
care for the patient. Additionally, collegiality among practitioners has long
been an ethical principle guiding practitioners actions. However, managed
OPHTHALMOLOGY CLINICS OF NORTH AMERICA
VOLUME 10 • NUMBER 2 • JUNF 1W Vli
care encourages practitioners to compete on the basis of guidelines devel¬
oped by the managed care organizations, rather than on providing what is
best for the patient. The structure of managed care predisposes health care
professionals to compete directly in negotiations, advertising, and other
areas that are not related to patient care. A polarization has occurred in the
profession as it tries to react in a way which is ethically responsible and
yet will provide financial security. One solution to the dilemma is to educate
patients so they can become more knowledgeable regarding physicians and
how they can encourage a system based on merit rather than finance.
How a Managed Care Contract Impacts on Ophthalmic Care 169
James Lewis Griffith and Patricia Sons Binswanger
Physicians should not sign contracts with managed care institutions before
familiarizing themselves with the ways in which managed care will affect
them, their practice, and their patients. This article reviews the different
kinds of managed care organizations, describes the possible effects of man¬
aged care on a physician s professional life, and provides a legal framework
to indicate ways to deal with problems arising from managed care.
Patient Rights and Managed Care 183
John W. Lewis
The rights of patients and the duties of those who provide their health care
are based on the needs of frail human beings, and are not a function of
economics or health care delivery systems. Health care has always been
managed, and has always required a fiduciary oath of those who wish
to provide such services.
The Role of the Physician in Cost Control 191
Jerry A. Menikoff
The managed care environment imposes pressure on physicians to make
decisions that will help cut the costs of medical care. Insofar as these deci¬
sions may reduce the level of care received by certain patients, they might
initially be viewed as running contrary to ethical mandates, perhaps even
constituting malpractice. It is being increasingly realized, however, that
there is a proper role for physicians in acting to cut costs, and such appro¬
priate actions can be both ethical and within the bounds of the legal standard
of care. The physician s difficult task is to determine which cost cutting
actions are permissible.
Information Systems, Quality Management, and Network Integration:
Are You Ready for Managed Care? 197
Mark C. Ruchman
Information systems, quality management, and network integration are the
three capabilities that decide whether companies will succeed or fail in the
era of managed care. These capabilities provide the foundation for the new,
vibrant intellectual infrastructure on which the practice of medicine will
be based. Physician organizations will be challenged to master these new
core capabilities.
Marketing Ethics in Ophthalmology 211
Samuel Packer
The commercialization of Medicine brings with it market forces. Physicians
have often been uncomfortable with aspects of marketing. This article clari
viii CONTENTS
fies the ethical issues that require attention as managed care organizations
incorporate physicians into their efforts to increase profits and market share.
Physicians Response to Managed Care 219
Thomas S. Harbin, Jr, and Kristine A. Morrill
The growth of managed care has required that many physicians change
they way they practice medicine. This article explores the options available
to ophthalmologists participating in managed care.
Managed Care and Its Impact on Research and Education 233
Joseph E. Robertson and F. T. Fraunfelder
Managed care significantly affects academic research and education. If medi¬
cal scholars are to survive managed care, they must reexamine their ap¬
proach to the driving forces of supply and demand. The same issues affecting
academic health centers that provide for education also apply to research
as funding sources are tightening. More than ever, institutions wishing to
remain in research must develop innovative programs to save money, such
as sharing space, equipment, and personnel.
Effects of the Federal Antitrust Law on Horizontal Mergers of Single
Specialty Medical Practices 243
Joseph E. Robertson and Kevin L. Winthrop
In the current era of mandated heath care reform, consolidation of practices
among physicians is necessary to meet the goals of cost effective and high
quality care in this country. However, because the medical profession has
come under antitrust scrutiny in recent years, horizontal mergers require
advance recognition and utilization of precedents and procedures for mini¬
mizing the risk of antitrust action. This article reviews relevant antitrust
statutes and regulations, and summarizes issues that should be addressed
in the creation of viable, socially responsible horizontal mergers among
specialty physicians.
How Managed Care Alters the Physician s Perception of the
Medical Profession 253
George L. Spaeth
The method of reimbursing the health care professional is an important
part of the health care system. In order to respect the patient s autonomy
and protect the patient from exploitation, it is essential that the method of
reimbursement be apparent to patients. It is the professional s responsibility
to ensure that patients understand how the professional is being reimbursed.
This is especially important in situations in which the reimbursement is
hidden, as it may be in the Medicare system and certain types ot man¬
aged care.
The American Academy of Ophthalmology s Response to
Managed Care 2=5C)
David A. Durfee and Gilbert D. Weber
The leadership of the American Academy of Ophthalmology recognized
changes in health care trends in the late lWO s. The shift to managed care
and smaller, more exclusive physician groups was recognized, and new
programs and services were instituted for all members. Challenges were
created for both the organization and those leaders responsible for the
new programs. This article presents an overview of the Academy s efforts.
CONTEXTS IX
Special Articles
Managed Care, Accountability, and the Physician 265
Nicholas A. Hanchak
Accountability is health care s latest buzzword. Accountability for the
quality, outcomes, and cost of health care applies to the medical delivery
system at all levels. Report cards are one way to measure the quality of
health care that plans, physicians, and other providers deliver. This article
presents examples of how U.S. Healthcare uses report cards and other
tools to evaluate the quality and value of the care to which its members
have access.
Practice Management, Health Maintenance, and the Use of Computers
in Today s Medical Office 277
Ronald J. Brooks, Joel A. Kahn, and Robin L. Smith
Practice management is a subject that has not been a significant part of
physician training in either medical school or residency programs. This
article reviews the basic tenets of practice management and how they
can be adopted to improve the quality of care and the productivity of
a medical office. The ability to understand office data in today s managed
care environment may determine the success of a practice. The role of
computers in the medical office and their ability to assist the practice in
this task is presented.
Ethics and Managed Care 289
Robert L. Perkel
Managed care presents physicians with potential ethical dilemmas differ¬
ent from the dilemmas in traditional fee for service practice. The ethical
assumptions of managed care are explored, with special attention to the
evolving dual responsibilities of physicians as patient advocates and
entrepreneurs. A number of proposals are described that delineate issues
in support of and in opposition to managed care. Through an understand¬
ing of how to apply basic ethics principles to managed care participation,
physicians may yet hold on to the basic ethic of the fiduciary doctor
patient relationship.
Index 299
Subscription Information Inside back cover
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| spellingShingle | Ethics, law, and managed care Ophthalmology clinics of North America Ophtalmologie Programme soins organisés - législation et jurisprudence Programme soins organisés Ethik Recht Ethics, Medical Jurisprudence Managed Care Programs organization & administration Managed care plans (Medical care) Law and legislation Managed care plans (Medical care) Moral and ethical aspects Ophthalmology Practice Ophthalmology organization & administration Managed Care (DE-588)4461436-6 gnd Medizinische Versorgung (DE-588)4038270-9 gnd Augenkrankheit (DE-588)4112627-0 gnd |
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| title | Ethics, law, and managed care |
| title_auth | Ethics, law, and managed care |
| title_exact_search | Ethics, law, and managed care |
| title_full | Ethics, law, and managed care Samuel Packer .., guest ed. |
| title_fullStr | Ethics, law, and managed care Samuel Packer .., guest ed. |
| title_full_unstemmed | Ethics, law, and managed care Samuel Packer .., guest ed. |
| title_short | Ethics, law, and managed care |
| title_sort | ethics law and managed care |
| topic | Ophtalmologie Programme soins organisés - législation et jurisprudence Programme soins organisés Ethik Recht Ethics, Medical Jurisprudence Managed Care Programs organization & administration Managed care plans (Medical care) Law and legislation Managed care plans (Medical care) Moral and ethical aspects Ophthalmology Practice Ophthalmology organization & administration Managed Care (DE-588)4461436-6 gnd Medizinische Versorgung (DE-588)4038270-9 gnd Augenkrankheit (DE-588)4112627-0 gnd |
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