Managed Care

This essay has a total of 1426 words and 9 pages.


Managed Care












Managed Care





By

Debbie Barbaroussis-Goot


Regis University
Dr. Ron Shaver
April 16, 2001


To decide on whether or not an issue is considered ethical or moral we need the hard cold
facts. Facts expose or explain what is to be decided upon—not what the outcome
should be. Decisions regarding health care and mental health issues represent a major
portion of ethical and moral choices. As individuals we are not always able to understand
the justice, or fairness, behind the decisions supposedly based on hard cold facts.

Once upon a time being a therapist was considered a calling. The images of a counselor
sitting back in their comfy cushioned chairs listening to hours and hours of
patient’s dilemmas, heartaches and mental health issues have been replaced with the
hard cold facts that therapists today are fighting over customers while behaving according
to appropriately mandated practices. HMOs (health maintenance organizations) and PPOs
(preferred provider organizations) are the therapeutic callings today—managed care.

As therapists and patients it may be difficult to grasp the concept of “managed
care” as this system becomes prevalent in the mental health areas. Managed care is
any health care delivery system in which strategies are employed to optimize the value of
provided services by controlling their cost, promoting their quality, and measuring
performance to ensure cost-effectiveness. Managed care now dominates health care in the
United States. A managed care system actively manages both the medical and financial
aspects of a patient’s care(Corcoran,1996).

Three concepts are at the origin of argument with managed care: control of the treatment
plan, cost effectiveness, and quality of treatment. Current quality of care measurements
focus on limited and tangible evidence. How do we measure evidence of mental health
improvements? Who should make the decisions regarding mental health issues, the physician
or the Chief Financial Officer? Health is an issue which needs be left to the physician
while dollars and cents can remain with the financial officer. Managed care theoretically
may seem appealing, but most view managed care practices as emphasizing cost control over
quality.

The ethical arguments of managed care are dependent on the goals of the physician and the
provider. If the primary goal is always doing the best for the patient within the limits
of available resources and less interest for the bottom line then subjecting patients to
unnecessary risks is minimal. However, if the patient is regarded as a secondary issue
the physician and providers are ethically wrong. “It is the position of the
National Academies of Practice that is unethical to compromise a patient’s needs and
quality care concerns to satisfy financial objectives” (Pope, K. S. & Vasquez, M. J.
T., (1998) pg. 322).

The APA Ethical Principals of Psychologists and Code of Conduct (Section 4.09c) states,
“Prior to termination for whatever reason, except where precluded by the
patient’s or client’s conduct, the psychologist discusses the patient’s
or client’s views and needs, provides appropriate predetermination counseling,
suggest alternative service providers as appropriate and takes other reasonable steps to
facilitate transfer of responsibility to another provider if the patient or client need
ones immediately” (American Psychological Association, 1992, pp. 1597-1611).

As a result of managed care policy limitations, referrals may become necessary. Managed
care assumes the ability to predict how long it will take to heal mental health issues,
and may not include or recognize certain diagnosis. Managed care places a therapist in a
precarious position. Therapists will now need to make the “appropriate”
diagnosis to cover therapy while acting also for the managed care organization. This
practice called double agentry is one of the challenges facing managed care.

Other challenges are fidelity; which entails loyalty to the profession’s basic
ethical principles (the patient in need,) confidentiality; a supreme ethical principle
which may be compromised for variations in policies, supervisions, billing or collection
reasons, managed care now has the right to invade a patient’ file--failing to
protect the patient, and informed consent; which denies individual freedom of choice
Continues for 5 more pages >>




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