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Hippocrates and the health maintenance organization. A discussion of ethical issues
1George Washington University School of Medicine and Health Sciences, Washington, DC.
Insights
Health maintenance organizations (HMOs) present ethical challenges due to cost containment and access barriers. This analysis examines these issues and proposes solutions to uphold physician integrity within HMOs.
Area of Science:
- Medical Ethics
- Healthcare Management
- Health Policy
Background:
- Health maintenance organizations (HMOs) deliver a growing share of US medical care.
- Key features like cost containment and restricted access raise ethical questions.
Purpose of the Study:
- To evaluate the ethical implications of HMO structures.
- To identify strategies for preventing ethical abuses within HMOs.
Main Methods:
- Ethical analysis of HMO characteristics.
- Review of existing literature on healthcare ethics and managed care.
Main Results:
- Physician ethical challenges in HMOs are often manageable.
- Independent practice associations present unique ethical considerations.
- For-profit status of HMOs is a critical ethical factor.
Conclusions:
- Ethical standards can be maintained in HMOs with specific safeguards.
- Addressing cost-saving incentives and access barriers is crucial for ethical practice.
- Further attention is needed for ethical oversight in for-profit HMOs and IPAs.
Abstract:
Health maintenance organizations (HMOs) are providing an increasing proportion of medical care in the United States. Characteristics of these organizations such as cost containment, incentives to reduce spending by practitioners, and barriers to access for clients raise significant ethical concerns. This paper considers how these features of the HMO withstand ethical scrutiny and what may be done to prevent abuse. Generally, the challenges to the moral integrity of physicians practicing in HMOs are neither intractable nor in all cases unique, although special arrangements may have to be made to ensure that ethical standards are upheld. Independent practice associations pose particular problems. Finally, whether or not an HMO is a for-profit enterprise is a significant consideration.
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