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Ethics in Practice: Managed Care and the Changing Health Care Environment
Medicine as a Profession Managed Care Ethics Working Group Statement
- Gail J. Povar, MD;
- Helen Blumen, MD;
- John Daniel, MD;
- Suzanne Daub, MSW;
- Lois Evans, DNSc, RN;
- Richard P. Holm, MD;
- Natalie Levkovich;
- Alice O. McCarter, MSW;
- James Sabin, MD;
- Lois Snyder, JD;
- Daniel Sulmasy, OFM, MD, PhD;
- Peter Vaughan, PhD;
- Laurence D. Wellikson, MD;
- Amy Campbell, JD; and
- the Medicine as a Profession Managed Care Ethics Working Group*
- From the Medicine as a Profession Managed Care Ethics Working Group convened by the American College of Physicians Center for Ethics and Professionalism in partnership with the Harvard Pilgrim Health Care Ethics Program.
Abstract
Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders—patients, physicians, and managed care representatives, along with medical ethicists—to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient–physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient–clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues.
*For members of the Medicine as a Profession Managed Care Ethics Working Group, see the Appendix.
Article and Author Information
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This statement has been endorsed by the American College of Physicians; American Academy of Allergy, Asthma & Immunology; American Academy of Pediatrics; American Association for the Study of Liver Diseases; American Association of Clinical Endocrinologists; American Association of Public Health Physicians; American College of Rheumatology; American Diabetes Association; American Geriatrics Society; American Thoracic Society; Citizen Advocacy Center; Endocrine Society; National Committee for Quality Assurance; Renal Physicians Association; and Society of General Internal Medicine. It was endorsed by the American College of Physicians Board of Regents on 15 July 2001.
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Acknowledgments: The working group thanks Amy Campbell, JD, Susan Coyle, PhD, and other staff at the American College of Physicians Center for Ethics and Professionalism who worked on this project.
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Grant Support: This statement was developed as part of the project Managed Care Ethics: Principles to Guide Practice, which was funded by the Program on Medicine as a Profession of the Open Society Institute.
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Lois Snyder, JD, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, lsnyder{at}acponline.org.
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Current Author Addresses: Dr. Povar: Cameron Medical Group, George Washington University, 8700 Georgia Avenue, Silver Spring, MD 20817.
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Dr. Blumen: 107 East Lennox Street, Chevy Chase, MD 20815.
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Dr. Daniel: Virginia Physicians, Inc., 7702 Parham Road, Suite 205, Richmond, VA 23294.
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Ms. Daub: Fairmount Community Health, 1412–22 Fairmount Avenue, Philadelphia, PA 19130.
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Ms. Evans: University of Pennsylvania School of Nursing, 420 Guardian Drive, Philadelphia, PA 19104.
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Dr. Holm: Brookings Medical Clinic, 400 22nd Avenue, Brookings, SD 57006.
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Ms. Levkovich: Health Federation of Philadelphia, 1211 Chestnut Street, Philadelphia, PA 19107.
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Ms. McCarter: New Community Services, Inc., 116 Norfolk Street, Cambridge, MA 02139.
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Dr. Sabin: Department of Ambulatory Care and Prevention, Harvard Medical School, 133 Brookline Avenue, 6th Floor, Boston, MA 02215.
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Ms. Snyder: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
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Dr. Sulmasy: Saint Vincent Hospital and Medical Center, 153 West 11th Street, NR 815, New York, NY 10011.
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Dr. Vaughan: Fordham University Graduate School of Social Service, 113 West 60th Street, New York, NY 10023.
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Dr. Wellikson: Society of Hospital Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.
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Ms. Campbell: 18 Raven Wood, Rochester, NY 14624.
