Managed Care Organizations as Moral and Business Entities
It is indeed true that medicine ought to be considered as an enterprise that deals with the moral well-being of mankind, and therefore, it can be taken as a business entity. Delivery of healthcare services is the core mandate of managed care organizations. Even as they perform this role, it is pertinent to note that they deal with the moral entities of patients (Mains, Coustasse & Lykens, 2003). Also, MCOs have to balance their budgets in such a way that they can attend to patients and, at the same time, remain profitable and well sustained. This explains why they should be taken as businesses.
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Although cost reduction for third party payers and patients is one of the economic tenets of managed care organizations, shareholders and officers who run these organizations also demand profits from the services they offer. Group physician practices as well as healthcare entities run by individuals are also businesses. The profit margin which they require is, however, quite small because they have a small number of shareholders. One of the outstanding attributes of managed care organizations is that they strive to run business ethically because they employ rationing decisions in most instances. Needless to say, they tend to stand out among healthcare providers because the moral well-being is given top priority, even as the organizations are treated as business entities. Also, physicians who work in managed care organizations are expected to act as advocates both for the organizations and patients. Perhaps, the latter role seem to reemphasize the moral focus that is given to patients who seek healthcare services in managed care organizations (Mains, Coustasse & Lykens, 2003).
The idea in Physician Incentives: Managed Care and Ethics by Mains, Coustasse, Lykens
In the article, the authors sought to convey quite several ideas in regards to managed care systems. To begin with, the principle features of this type of the healthcare system have been reviewed by the authors. The main goal of undertaking this review is to create a vivid comprehension of how ethical assumptions are dominant in managed care systems. This implies that there are myriads of ethical concerns that are often part and parcel of managed care systems. For example, the authors posit that the physician-patient relationships, roles of patients, and physician incentives are instrumental in all managed care systems (Mains, 2003). There are also ethical tensions that are created by managed care systems, especially when it comes to the management of resources that are already scarce. Individuals who influence the distribution of such rare resources In managed care systems often find it difficult to accomplish specific goals. Moreover, the doctor-patient relationships have been changed by the administrative control of the managed care systems. As it stands now, the businessperson-consumer relationship has taken the center stage.
The authors also discuss the fact that there is a growing conflict between organizations and patients who have been put on the frontline to act as physicians in managed care systems. Their responsibilities seem to conflict due to duplication of roles. As a result, the authors suggest that the new roles of policy makers, payers, patients, and physicians can be brought into limelight and even improved when additional focus is channeled to the moral mission of the managed care systems (Mains, 2003). The cordial and faithful relationship that has always existed between patients and doctors will also be preserved.
The physician’s dual function under an MCO model of care
Patient fiduciary and financial advocacy are the two core functions of physicians under the MCO model of care. The physicians benefit from several monetary incentives. In regards to being the patient fiduciary, they are supposed to play the role of advocates on behalf of their patients. The latter role should be carried out without any restrictions. The exercise of beneficence and respect for freedom are therefore given secondary considerations within the confines of social justice (Ettinger & Lasser, 2008). There is a greater precedent that is taken by social justice when it comes to managed care organizations so that additional advantages can be realized in the relationship between physicians and patients. There is, however, still room for ethicists to argue whether social optimal outcomes or the well-being of patients should be prioritized. Nonetheless, the patient advocate duty is the main reason why physicians are trained.
The physician-patient relationship under MCOs
I suppose that the relationship between physicians and patients under the managed care organizations is quite impressive. For instance, physicians are supposed to be advocates to patients even as they discharge their roles. This relationship ensures adequate moral support for patients, even though it may pose an additional burden to the physicians. Nonetheless, these physicians also enjoy financial incentives that eventually lead to satisfaction in service delivery.
MCO as arrangements for patients
MCOs are good arrangements for patients because they receive full moral support. For example, patients are handled decently as valued individuals. The care the patients are provided with is supposed to be shrewd because the physician is expected to demonstrate prudent stewardship. The financial risks and medical benefits for patients are also well balanced by the physicians under this arrangement (Cooper & Rebitzer, 2004).
On the other hand, this arrangement may not be favorable to patients in some cases. The physician-patient relationship may be destroyed by lack of honesty, care, and trust from the physicians (Creighton, 2004). For instance, there are several physician’s obligations that have not been addressed by the code of ethics. Preventive services and universal healthcare access are non-existent in this code.
Cooper, D.J. & Rebitzer, J.B. (2004). Managed Care and Physician Incentives: The Effects of Competition on the Cost and Quality of Care. Web.
Creighton, S.A. (2004). Diagnosing Physician-Hospital Organizations: Remarks before the American Health Lawyers Association, Program on Legal Issues Affecting Academic Medical Centers and Other Teaching Institutions. Web.
Ettinger, D.A. & Lasser, M. (1997). Government Agencies Soften Stance on What Constitutes Price Fixing. Healthc Financ Manag, 51(2), 27-29.
Mains, D.A., Coustasse, A. & Lykens, K. (2003). Physician Incentives: Managed Care and Ethics. The Internet Journal of Law, Healthcare and Ethics 2(1), 1-8.