Healthcare ethics committees and managed care

Healthcare ethics committees (HECs) play an important role in medical decision making in US hospitals, but no study has determined whether HECs deal with managed care, in any form. This pilot study was performed to evaluate the activities and perceptions of HECs about managed care.

Forty-five hospitals in the Philadelphia area were selected at random, and comprised 36.6% of area institutions and 47% of area inpatient beds. Surveys were administered to ethics committee representatives by the authors in 1998.

Survey responses were coded, and both tabulated responses and analyzed data are presented. Correlations were analyzed with the unpaired 2-tailed t test.

HECs devoted 7.6% of committee time to managed care issues, and the remainder to education, policy development, and case consultation. Time spent on managed care issues depended on the size of the institution (small hospitals spent twice the time on managed care as did large institutions); composition of the committee (presence of clergy and retirees on HECs correlated with the likelihood that HECs would address managed care issues); and whether the HEC was requested to help with managed care issues. Of the HECs surveyed, 18% had formal but disparging discussions of ethical concerns in managed care. The impact of changing insurance programs on the hospital and HECs was a concern.

HECs arbitrate ethical conflicts in managed care when asked. As the presence of managed care increases, ethics committees will increasingly be called on to resolve the resulting ethical dilemmas. To be effective in this role, HECs must become knowledgeable about managed care principles and policies.