Physician Incentives: Managed Care and Ethics, Essay Example

Introduction

According to the authors of Physician Incentives: Managed Care and Ethics, “the clinical decision making of these providers is influenced by the managed care organizations (MCOs) through financial incentives, utilization management and quality assurance programs” (Mains et al. 1). As such, it is necessary for MCOs to balance several different needs, including the balance between ethical requirements and financial incentives. The authors of the paper argue that because medicine is a moral enterprise, MCOs are moral entities as well. However, while MCOs should operate according to moral standards, it is also important to consider that they function as businesses and businesses are therefore most likely to participate in the decisions that will incur the highest degree of profit. As such, it is most probable that MCOs operate according to ethical standards when these standards are seen to be profitable. On the other hand, it appears that these organizations would be willing to dismiss these standards if it meant gaining a reasonable profit.

Discussion

The main points of the paper are that the managed care system has a significant impact on the allocation of financial and physical resources and that it encourages physicians to act as businessmen. As a consequence, managed care systems appears to create a major conflict of interest in the health care setting. The authors therefore conclude that MCOs are not highly ethical in nature. While they were designed to protect the interests of the patients, they are no longer serving this necessary function. One such issue is that because high fees are common in health care, the care of the patient is often compromised as a result (Kolata 1). Health care has become a money making business instead of an industry that is meant to defend the health and rights of the patients.

Under the MCO model of care, the physician is also a businessman. Therefore, they need to balance business ethics with health care ethics. In spite of this dual role, there is a need for the physician to work as a patient advocate in spite of their duties as a businessman. Effective professionals are able to effectively balance these two roles. It is important for the physician to make some level of profit to counteract the rising costs of providing health care to clients. However, it is necessary for them to avoid doing so in a manner that becomes detrimental to the patient. This is often accomplished by passing costs to members of third parties when reasonable (Cox 48).

Conclusion

I am personally concerned about the physician-patient relationship under MCOs because I am worried that the care of individuals living in poor neighbourhoods will be compromised. Since these individuals do not have money to afford insurance options with full coverage but may not be eligible for federal care, it is likely that physicians in their areas will spend less time with them overall to ensure that they are able to see the quantity of individuals necessary to turn a profit. This is unfortunate because it will continue to contribute to the disparity of care in these areas.

References

Cox, T. Professional caregiver insurance risk: A brief primer for nurse executives and Decision Makers. (2006). Nurse Leader, 4(2): 48–51. Retrieved from http://www.nurseleader.com/article/S1541-4612(06)00048-6/references

Kolata G. Survey Finds High Fees Common in Medical Care. (2015). Retrieved from

Mains D, Coustasse A, Lykens K. Physician Incentives: Managed Care and Ethics. (2003). The Internet Journal of Law, 2(1). Retrieved from http://ispub.com/IJLHE/2/1/12416