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Medicine and MCOs Businesses, Term Paper Example

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“Medicine is a moral enterprise. Because MCOs are involved in the delivery of medical care, they, too, are moral entities. However, MCOs are also businesses

This article clearly advances that the managed care typology practiced in United States of America has greatly removed the patient centered empathy of care delivery whereby patients receive what their insurance plans can provide through the system and adjuster saying what they can have through allocations of the business. This is demoralizing to American citizens who pay taxes and social security to receive for their labor of love to this country. It does not have to be like this. American healthcare has been classified the worst for developed nation due to this Managed Care Practice (Mains et.al, 2004).

Explain the idea that the authors sought to convey

The idea these authors are trying to convey is that  Managed care principles as practiced in the American society has serious ethical implications as it relates to physicians’ responsibility to patients and patients’ expectation of their physicians and the health care system. Importantly, they highlighted that ‘managed care goals of quality and access demand’ (Mains et.al, 2004, abstract) actually conflict in physicians’ being advocates for their patients as well as the organizations within which they function. The organization’s goal is to maximize profit and cut cost whereas the physician’s responsibility is to offer the best quality care. Ethically, they do not match (Cox, 2010).

Reemphasizing the moral mission of managed care is essential at this time. It is expected to sensitize physicians to their role of preserving patients’ fidelity while at the same time maintaining the integrity of Managed care organization. At times becomes very difficult to maintain (Kolata, 2009).

Discuss the physician’s dual function under an MCO model of care.

The physician’s dual function under an MCO model of care creates a moral difficulty in being aligned to a patient’s right to quality care and the organization’s desire to maximize profits. How a physician could just reduce appropriate services because the organization’s adjuster does not value his /her decision as a specialist practitioner or health care provider? The adjuster is actually undermining the physician’s ability to make a decision that would improve the patient’s health. Who has a better expertise of evaluating healthcare services? Is it the adjuster or physician who is trained in health care quality delivery? Herein lays the dilemma! To whom should physician be loyal the patient or organization? (Wisconsin Department of Health Services, 2013).

What concerns do you have about the physician- patient relationship under MCOs?

My concern regarding the physician-patient relationship under MCO is that while my primary care may be knowledgeable in his practice due to the conditions through which he/she has to practice I may never receive that high quality of service because always a choice has to be made between me and the adjusted care I ought to received based on the system. This is simply ridiculous and immoral. Where has morality in American health care system gone?

References

Cox, T. (2010). Legal and ethical implications of health care provider insurance risk assumption. JONAS Healthcare Law, Ethics and Regulation. 12(4):106-16.

Mains, A. Coustasse, A. Lykens. K (2003). Physician Incentives: Managed Care and Ethics. The Internet Journal of Law, Healthcare and Ethics

Kolata, G. (2009). Survey Finds High Fees Common in Medical Care The New York Times.

Wisconsin Department of Health Services (2013). Managed Care Organizations. DHS.

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