Managed Care Essays - Primary Care, Mental Health, Health Care

Managed Care Managed Care By Debbie Barbaroussis-Goot Regis University Dr. Ron Shaver April 16, 2001 To decide on whether or not an issue is considered ethical or moral we need the hard cold facts. Facts expose or explain what is to be decided uponnot what the outcome should be. Decisions regarding health care and mental health issues represent a major portion of ethical and moral choices. As individuals we are not always able to understand the justice, or fairness, behind the decisions supposedly based on hard cold facts. Once upon a time being a therapist was considered a calling. The images of a counselor sitting back in their comfy cushioned chairs listening to hours and hours of patients dilemmas, heartaches and mental health issues have been replaced with the hard cold facts that therapists today are fighting over customers while behaving according to appropriately mandated practices. HMOs (health maintenance organizations) and PPOs (preferred provider organizations) are the therapeutic callings todaymanaged care. As therapists and patients it may be difficult to grasp the concept of managed care as this system becomes prevalent in the mental health areas. Managed care is any health care delivery system in which strategies are employed to optimize the value of provided services by controlling their cost, promoting their quality, and measuring performance to ensure cost-effectiveness. Managed care now dominates health care in the United States. A managed care system actively manages both the medical and financial aspects of a patients care(Corcoran,1996). Three concepts are at the origin of argument with managed care: control of the treatment plan, cost effectiveness, and quality of treatment. Current quality of care measurements focus on limited and tangible evidence. How do we measure evidence of mental health improvements? Who should make the decisions regarding mental health issues, the physician or the Chief Financial Officer? Health is an issue which needs be left to the physician while dollars and cents can remain with the financial officer. Managed care theoretically may seem appealing, but most view managed care practices as emphasizing cost control over quality. The ethical arguments of managed care are dependent on the goals of the physician and the provider. If the primary goal is always doing the best for the patient within the limits of available resources and less interest for the bottom line then subjecting patients to unnecessary risks is minimal. However, if the patient is regarded as a secondary issue the physician and providers are ethically wrong. It is the position of the National Academies of Practice that is unethical to compromise a patients needs and quality care concerns to satisfy financial objectives (Pope, K. S. & Vasquez, M. J. T., (1998) pg. 322). The APA Ethical Principals of Psychologists and Code of Conduct (Section 4.09c) states, Prior to termination for whatever reason, except where precluded by the patients or clients conduct, the psychologist discusses the patients or clients views and needs, provides appropriate predetermination counseling, suggest alternative service providers as appropriate and takes other reasonable steps to facilitate transfer of responsibility to another provider if the patient or client need ones immediately (American Psychological Association, 1992, pp. 1597-1611). As a result of managed care policy limitations, referrals may become necessary. Managed care assumes the ability to predict how long it will take to heal mental health issues, and may not include or recognize certain diagnosis. Managed care places a therapist in a precarious position. Therapists will now need to make the appropriate diagnosis to cover therapy while acting also for the managed care organization. This practice called double agentry is one of the challenges facing managed care. Other challenges are fidelity; which entails loyalty to the professions basic ethical principles (the patient in need,) confidentiality; a supreme ethical principle which may be compromised for variations in policies, supervisions, billing or collection reasons, managed care now has the right to invade a patient file--failing to protect the patient, and informed consent; which denies individual freedom of choice forced upon the individual with limitations in policy coverage. Two other challenges are honesty; which within the system may produce exaggerated or false claims to ensure payment, also allowing dishonest physicians to make arrangements with the managed care providers, and finally, vulnerability; which creates the potential for lowering various quality of care standards that