Reproductive health under managed care: expanding provider obligations

The discussion of ethical issues in managed care can be focused on two general areas. The first of these is the impact of the shift toward managed care on the fiduciary relationship between health care professional and patient, including the issue of trust, the potential for conflict of interest, and the impact of cost-saving strategies on the clinician's ability to address a patient's health care needs. The second is the attention to justice that managed care demands. Health care professionals must take issues in both areas into account, attempting to balance obligations to individual patients with obligations to patients collectively. Strategies for doing so are discussed.