Ethical Issues in Managed Care

Abstract

A PRIMARY concern of medical ethicists for some time has been the absence of any meaningful analysis of the impact of health care delivery marketplace changes and current legislative reforms on the essential tenets of the physician-patient relationship. Although President Clinton's original reform proposal addressed in broad terms the ethical imperatives supporting universal access, it left virtually unexamined the more fundamental question of the role of the physician in a reformed system in which the incentives are dramatically changed and budgets determine the amount of health care spending and services. See also pp 323 and 338. In June 1990, the Council issued a report, "Financial Incentives to Limit Care: Financial Implications for HMOs and IPAs,"¹which described the financial incentives that managed care plans offer physicians to limit their provision of care. The report concluded that patient welfare must remain the first concern of physicians working in health maintenance