Managed care: rationing without justice, but not unjustly

Area of Science:

• Bioethics
• Health Policy
• Medical Economics

Background:

• Managed care organizations (MCOs) are frequently criticized on ethical grounds.
• Common criticisms include
• skimming
• healthy patients, rationing care, and interfering with physician's fiduciary duties.

Purpose of the Study:

• To critically evaluate common ethical criticisms leveled against managed care.
• To identify the fundamental ethical flaw of managed care, distinct from superficial criticisms.

Main Methods:

• Philosophical analysis of ethical arguments concerning managed care.
• Examination of assumptions underlying criticisms of MCOs' impact on access and rationing.
• Critique of the concept of
• adequate care
• in the US healthcare system.

Main Results:

• The common criticisms of managed care regarding patient access and rationing are based on flawed assumptions.
• Managed care organizations do not inherently worsen access; the healthcare system lacks a clear division of responsibility.
• The concept of a universally entitled
• adequate level of care
• is not established in the US.

Conclusions:

• The ethical criticisms of managed care concerning access and rationing are misconceived.
• The fundamental ethical issue with managed care lies in its institutional structure, which disconnects rationing from principles of justice.
• A re-evaluation of managed care's ethical standing requires addressing its systemic implications for justice.