Ethical Issues in Managed Care:

1
TOPIC

• Ethical Issues in Managed Care
• The Effects of Cost Containment Techniques on the
  Patient-Physician Relationship.
• By,
• Tia Billingsley

2
Thesis

• Through reflection of 18th century Philosopher
  Immanuel kants theory of the Categorical
  Imperative, and its second formula, The Formula
  for the End in Itself, it will be proven that
  cost containment techniques within managed care
  compromises the quality and integrity of the
  patient-physician relationship.

3
Why Managed Care??

• In 2005 (the latest year of available data), the
  U.S. health care spending was 2 trillion and is
  projected to reach 2.9 trillion in 2009
• Obvious need to control health care costs
• Resulted in the development and evolution of
  managed care
• Originated in 1940
• HMO earliest forms of managed care
• IPA
• PPO
• POS

4
What is a cost containment technique?

• Any technique used in an attempt to limit health
  care expenditures.

5
Physician Behavior

• Must balance the interests of their patients with
  the interests of other patients
• Encouraged to ration their use of diagnostic
  tests, referrals to other physicians, and
  hospital care or ancillary services
• Use of financial incentives, namely, bonuses
• When physicians are deciding whether to order a
  test,
• they are forced to recognize that it may have an
• adverse impact on their income.

6
Patient Behavior

• Patients are told their choice of primary care
  physicians, and specialists
• Patient Autonomy-Freedom of choice
• Patients are denied particular medical treatments
• Erosion of trust between patient and physician

7
Immanuel Kant

• Categorical Imperative
• The Formula for the End in Itself
• treat people always as ends in themselves, never
  as mere means.
• everyone, insofar as he or she is a rational
  being, is intrinsically valuable
• we ought therefore to treat people as having a
  value all their own rather than merely as useful
  tools or devices by means of which can satisfy
  our own goals or purposes
• (kant)

8
Conclusion

• According to Immanuel Kants theory of the
  Categorical Imperative and its second formula,
  The Formula for the End in Itself it is unethical
  to use cost containment techniques because they
  compromise the quality and integrity of the
  patient-physician relationship.

9
Works Cited

• Catlin, a, C. Cowan, S. Heffler, et al,
  National
• Health Spending in 2005. Health Affairs 261
  (2006) 142-153
• Chamber, H. Ethical Issues in Managed Care.
  1994-1995. lthttp//www.amassn.org/ama
• /upload/mm/369/ceja_report_060.pdfgt
• http//www.iep.utm.edu/s/soc-cont.htmSH3a