Managing Care: A Shared Responsibility / Edition 1by Joseph L. Verheijde
Pub. Date: 12/22/2005
Publisher: Springer Netherlands
Effective management of appropriate health care should contain medical care costs, improve accessibility, and address rationing concerns. However, managed care in the United States has not lived up to these expectations. Employers and public policy makers view managed care as a way to curb excessive health care insurance costs, but these organizations operate without… See more details below
Effective management of appropriate health care should contain medical care costs, improve accessibility, and address rationing concerns. However, managed care in the United States has not lived up to these expectations. Employers and public policy makers view managed care as a way to curb excessive health care insurance costs, but these organizations operate without societal agreement on critical issues such as a workable definition of health, an authoritative definition of entitlements, and the distribution of labor between public and private sectors. The U.S. health care system is also characterized by decentralization and the absence of a comprehensive health care planning or budgeting system, substantive access rules, and agreed-upon minimum health care benefits. Thus, the responsibilities of managed care organizations are limited. The leading cause of the inability to manage health care appropriately is the lack of a shared unifying paradigm of responsibility. Health care stakeholders operate by widely varying interpretations of responsibility. Genuine responsibility, recognizing the complexity of health care and the need for stakeholder-specific interpretations of responsibility, proposes as its underlying premise the social agreement that distributive choices be made according to the premise of deliberate reciprocity. When all stakeholders share the same foundation for the notion of responsibility, the resulting trust and cooperation facilitates morally appropriate solutions to health care reform.
Table of Contents
Part 1. Health care costs and scarcity. 1. Introduction. 2. Development of Managed Care. 2.1 The concepts of "costs". 2.2 Economic restraints. 3. Rationing: A dilemma for ethicists. 3.1 Scarcity is an economic reality. 3.2 Ethics and rationing. 3.3 Medical necessity. 3.4 Cost effectiveness and cost benefit analysis. 3.5 Affordability. 3.5 A comprehensive approach. 3.6 Talking about responsibility. 4. Responsibility. 4.1 What is the distribution claim made by agency theories? 4.2 Normative weakness. 4.3 Responsibility: the key notion. 4.4 "Genuine responsibility" as a proposal for a unifying paradigm. Part 2. The concept of managed care and its practical implications. 1. Introduction. 2. Quality of Care in Managed Care. 2.1 Fairness in managed care. 2.2 Public distrust. 3. History of Managed Care. 3.1 Economic Pressure. 3.2 Medical Waste as a Contributor to Cost. 4.Where does managed care find its market. 5. Definition of managed care. 5.1 Different forms of managed care. 5.2 Implications of managed care. 5.3 Characteristics of managed care. 5.4 Expectations and disappointments. 6. Managed care as unknown territory. 6.1 Distribution by managing outcomes. 6.2 Utilization versus best practice data. 6.3 What ought to be versus what is. 7. Methodological concerns regarding data collection. 7.1 Normative concerns about data. 8. Population-based distribution and individual autonomy. 8.1 Reconsidering medical paternalism. 8.2 Foundation of a rights-orientated health care. 9. Balancing responsibilities. 9.1 Denial of liability and accountability. 9.2 Responsibility of MCOs to members. 10. Changes in managed care. 10.1 The obvious question. Part 3. Ideology: the silent partner. 1. Introduction. 2. The concept of ideology. 3. Ideology in medicine. 3.1 Ideological components in the definition of health. 3.2 Models of causation of disease and their ideological relevance. 4. The context of scarcity and its ideological impact on health care. 4.1 The ideological context of the model of rationing and its symbolicy forms. 5. Conclusion. Part 4. Concept of Genuine Responsibility. 1. Introduction. 2. Changing the focus in health care distrisbution. 2.1 Unlimited access versus cost containment. 2.2 An analogy. 2.3 An ethics approach. 2.4 Rationality and Empathy. 3. The notion of responsibility. 3.1 An ethics of genuine responsibility. 3.2 The definition of "Genuine Responsibility". 3.3 Implications on the notion of personal responsibility. 4. Justice and health care. 4.1 Just health care. 4.2 The odds of just health care. 4.3 Impediment to justice. 5. Key presumptions. 5.1 Challenging the notion of responsibility in managed care. 5.2 Health care distribution in a free-market economy. 5.3 Justice as appropriation. Part 5: Revising the template for modeling health care. 1. Introduction. 2. Necessity for change. 2.1 Recapitulating the applied theoretical framework. 2.2 The ideological argument in the health care debate. 3. Defining health and health care. 4. The main parties involved. 4.1 Society. 4.1.1 Justice and public policy making. 4.1.2 The contribution of justice as appropriation. 4.1.3 The contribution of genuine responsibility to the debate. 4.1.4 Defining entitlement to healthcare. 4.2 Government. 4.2.1 Privatization and cost containment. 4.2.2 Empirical observations. 4.3 Recapitulation. 4.3.1 Genuine responsibility and health care business. 4.4 Managed care organizations. 4.4.1 Business as moral agent. 4.4.2 Corporate citizenship in the market place. 4.4.3 Corporate responsibility and the healthcare business. 4.4.4 Prioritization of interests. 4.4.5 The nature and the scope of responsibility. 4.4.6 Solidarity and the notion of universal access. 4.4.7 The implications for managed care organizations. 4.4.8 Two alternatives for control. 4.4.9 How genuine responsibility would guide managed care distribution. 4.4.10 Compliance or integrity behavior. 4.4.11 Accounting for the focus on for-profit managed care organizations. 4.4.12 Effects of the Principle of Genuine Responsibility on Managed Care. 4.5 What does genuine responsibility expect from health care professionals? 4.5.1 Physician as gatekeeper of faithful provider. 4.5.2 Best practice and practice guidelines. 4.6 Individual members of the moral community. Part 6: Theoretical reflections. 1. Introduction. 2. Managed care. 2.1 Public frustration. 2.2 Healthcare as business. 3. The problem: who is responsible for what? 3.1 Defining responsibility. 3.2 Genuine responsibility. 4. Justice as Appropriation. 4.1 Ideology and discourse ethics. 5. A template for responsible healthcare distribution. 5.1 Realism or idealism? Part 7: Implementation in U.S. Health Care System: Challenges and Opportunities. 1. Introduction. 2. Changing the views on business and profits. 3. Individual entitlement and social justice. 3.1 What is just? 3.2 Moral authority. 3.2.1 Necessary conditions anchoring moral authority. 4. The role of government. 4.1 Covering the basics. 4.2 Government involvement. 4.3 The domain of government’s responsibility. 4.4 Obstacles to a Subsidy Model. 5. Health care planning. 5.1 Government mandated health planning. 5.2 The argument for government involvement. 5.3 From theory to practice. 5.4 Discussing the options. 5.5 Determining priorities.6. Health care budgeting. 6.1 Implementing budget-based delivery systems. 6.2 Decentralized healthcare. 7. Special interest groups and policy making. 7.1 Reviewing options. 7.2 Substantive access rules. 7.3 Practical challenges. 8. The minimum health care benefit package. 9. The contribution of evidence based medicine. 9.1 Practice guidelines. 9.2 Theory and practice; Coming full circle. 9.3 Closing the loop. Bibliography. Index.
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