Ethical questions under managed care begin to surface in the literature

Defining the specific ethical issues anticipated under integrated health care delivery systems is difficult for several reasons: (1) We don't know with certainty what structures, processes, and rules will be in place, and (2) the lines of authority and accountability are still unsettled. Despite these unknowns, everyone seems fairly certain that managed care processes within a structure of managed competition will be permanent and prominent fixtures in the reformed environment of health care. The following articles summarize three recent articles on life under managed care. The first two reflect the concerns of physician-ethicists, and the third makes an effort to think of ethical obligations at the organizational level.