4120.0: Tuesday, November 14, 2000 - 1:30 PM

Abstract #11323

Managed care organizations and the rationing problem

Mary Ann Baily, PhD, Fellow, Institute for Ethics, Ethics Standards Division, American Medical Association, 515 North State Street, Chicago, IL 60610, 312-464-5438, mary_ann_baily@ama-assn.org

The role of organizations in health care financing and delivery has increased in recent years, in response to technological change and cost containment pressures. These organizations are more likely to be for-profit enterprises than in the past, and whatever their profit orientation, must cope with radically changed financial incentives and constraints. These changes have contributed to a reduction in public trust in health care organizations and confusion on the part of those who run them about what they should be doing, resulting in an active public debate on organizational ethics in health care.

This paper looks at a key topic in this debate, the role of managed care organizations (MCOs) in health care rationing. The paper considers two basic questions from the contrasting perspectives of bioethics and economics: how managed care organizations should determine the standard of care they guarantee and the role physicians should play in rationing in a managed care environment. It argues that there is a disconnect between the market framework within which MCOs organizations must operate and the way that bioethicists think about their ethical obligations. Either the economic framework or the conceptualization of organizational ethics must be changed, and in fact, the optimal policy is to change both. The paper concludes with a discussion of the changes necessary and possible policy options for bringing them about.

Learning Objectives: At the conclusion of the session, the participant will be able to discuss the conflicting pressures managed care organizations face in trying to ration health care ethically, and identify changes in organizational ethics and in the market environment that could clarify ethical obligations and make them more manageable

Keywords: Managed Care, Rationing

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA