LETTER
Managed Care Ethics
Andrew L. Kosseff, MD
15 October 1998 | Volume 129 Issue 8 | Page 672
TO THE EDITOR:
In their article "Ethical Practice in Managed Care," Hall and Berenson [1] suggest that bedside rationing of care is the logical response to cost constraints imposed by managed care. Physicians have always had an ethical responsibility to provide the highest quality of medical care to their patients, and this mandate should continue no matter what type of care environment exists. Managed care and its related payment methods do not fundamentally alter physicians' responsibility to their patients but add the imperative of finding ways to improve the value of care (the best quality for the most appropriate cost).
Managed care is forcing physicians to determine what constitutes health care waste and what adds value. The desired result is to reduce expenditures and maintain or improve the quality of care. Bedside care and advocacy, but not rationing, continue to be our primary responsibility. Managed care has added the obligation and opportunity to find innovative ways to improve the value of health care. If we do our jobs effectively, waste will be reduced and we will never have to deny needed care to patients.
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Author and Article Information
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Dean Health Systems; Madison, WI 53705
1. Hall MA, Berenson RA. Ethical practice in managed care: a dose of realism. Ann Intern Med. 1998; 128:395-402.
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