Group-level ethics in managed care

Managed care, the newest scheme for health care delivery, is under fire for skimping on quality, hiding information from patients and restricting free choice of providers. Medical group managers now face ethical questions quite unlike the medical ethics taught in medical schools. The new questions are about how the entire network of U.S. health care institutions work. Five principles can guide an appropriate ethics for this group-level reflection: 1) institutions are means to support the common-wealth, not ends in themselves; 2) people have a right to shape their health care options; 3) competition does not exclude collaboration; 4) a proper cost-benefit analysis will regard the entire community, not merely one institution; and 5) mission statements should be written by the people involved in delivering the care.