CONTACT: woodstock@georgetown.edu The Woodstock Theological Center announced today the publication of Ethical
Issues in Managed Health Care Organizations by the Georgetown University
Press. This publication is a consensus statement to which all of the 54
seminar participants subscribe after two years of study and four major
conferences. Participants represent all aspects of managed health care:
physicians, nurses, and other clinicians, executives and medical directors
of health care organizations, corporate purchasers of healthcare plans,
directors or presidents of national associations, and academic experts
in ethics and economics. The document reviews the ethical problems that
decision makers in managed care organizations confront, examines the origins
and complexity of these problems, and recommends a framework for assessing
and balancing the competing values at stake in each issue. The publication
also offers suggestions for decision-making processes that can help professionals
working in a managed care environment respect and appreciate the various
perspectives that their fellow professionals bring to these conflicts,
and negotiate their way to workable, ethically sound policies, decisions,
and actions. The fourth in a series of Woodstock business
ethics seminars, the study was funded by The Robert Wood Johnson Foundation.
Jesuit Father James L. Connor, director of the Woodstock Theological
Center says, "We hope the document will help to spur a national debate
and discussion not only about the decisions that are being made
by private actors in the health care system, but also about the processes
being used by those actors to reach those decisions. We believe that to
be ethical, as well as to be politically viable in the long run, the decision-making
processes used by clinical and administrative decision makers in managed
care must have mechanisms for systematically taking into account the impact
of their decisions on all stakeholders, and must be open to scrutiny by
those stakeholders." Included in the 42-page publication are examples of ethical dilemmas
or "case studies." The examples are fictional, but are based
on the actual experiences of the practitioners who participated in the
Woodstock project. The back pocket of the publication contains a handy
"pull-out" card that summarizes the set of questions that managed
health care executives and managers should ask themselves in the process
of making day-to-day decisions that involve ethical conflicts. The first section of the publication addresses the rapid and revolutionary
transformation of the health care delivery and financing system in the
United States. Because of the massive shift by the purchasers of health
care benefit packages away from a "fee-for-service" system towards
various kinds of managed health care plans, emerging new organizational
arrangements have changed the day-to-day operating environment for health
care system managers and executives, physicians and clinicians, and patients.
Consequently, executives, clinicians, and other decision makers face a
continual stream of competing demands and value conflicts. The fact that
decision making in the managed care context is often so inherently conflict-laden
has made it increasingly difficult for managed health care administrators
to sustain public trust. Yet, participants in the Woodstock project came
to understand that if such conflicts are confronted directly and dealt
with in a well-considered way that responds to all of the legitimate stakeholders
and affirms their values, managed care "may hold out a hope of providing
a new vision for sustainable, efficient, socially responsible, and ethically
sound health care delivery in the United States." To have any hope
of reaching that goal, managed care organizations must institute decision-making
processes that promote ethical choices. Section two, "Roots of the Ethical Dilemmas," reviews how and
why managed care has emerged as an alternative to traditional "fee-for-service"
insurance. Courses of action that can help decision makers reach workable and ethically
acceptable resolutions are discussed in section three. An eight-step process
for ethical decision making is outlined. Section four, "Putting the Process to Work," reports on the
efforts of one group of Woodstock seminar participants to make a decision,
using the eight-step process, on a specific managed health care case study.
These efforts are presented in narrative form to highlight the complexities
of the case, to illustrate the practical use of the process, and to capture
the moral and emotional issues that the participants confronted. In the publication’s final section, the seminar participants, while
affirming that "managed care is potentially a morally acceptable,
even beneficial enterprise," note that the system is still evolving.
The ultimate moral and political judgment about managed care as a system
will depend on how the industry evolves over the next few years. Ethical Issues in Managed Health Care Organizations is available
from the Woodstock Theological Center for $8.00 a copy, $2.00 postage
and handling. Bulk rates are available. Previous Woodstock business ethics seminar publications are Ethical
Considerations in the Business Aspects of Health Care (1995),
Creating and Maintaining an Ethical Corporate Climate
(1990), and Ethical Considerations in Corporate
Takeovers (1990). More than 20,000 copies of these publications
have been sold or distributed. The Woodstock Theological Center, located on the Georgetown University
campus, is a nonprofit independent research institute sponsored by the
Society of Jesus. The Center addresses topics of social, economic, and
political importance from a theological and ethical perspective. Editors’ note: review copies of Ethical Issues in Managed Health
Care Organizations are available upon request.
For Immediate Release/January 22, 1999See also: