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Volumn 9, Issue 2, 2000, Pages 189-204

Conflicts of interest and management in managed care

(2)  Agich, George J a   Forster, Heidi a  

a NONE

Author keywords

[No Author keywords available]

Indexed keywords


EID: 0034349037     PISSN: 09631801     EISSN: None     Source Type: Journal    
DOI: 10.1017/s0963180100902068     Document Type: Article
Times cited : (8)

References (61)
  • 1
    • 0029072274 scopus 로고
    • Managed care and the morality of the medical marketplace
    • 1. Kassirer JP. Managed care and the morality of the medical marketplace. New England Journal of Medicine 1995; 333:50-2.
    • (1995) New England Journal of Medicine , vol.333 , pp. 50-52
    • Kassirer, J.P.1
  • 2
    • 0028887888 scopus 로고
    • Ethical issues in managed care
    • 2. American Medical Association Council on Ethical and Judicial Affairs. Ethical issues in managed care. JAMA 1995; 273:330-5.
    • (1995) JAMA , vol.273 , pp. 330-335
  • 3
    • 0023339084 scopus 로고
    • Incentives and obligations under prospective payment
    • 3. Agich GJ. Incentives and obligations under prospective payment. Journal of Medicine and Philosophy 1987; 12:123-44.
    • (1987) Journal of Medicine and Philosophy , vol.12 , pp. 123-144
    • Agich, G.J.1
  • 5
    • 0002251064 scopus 로고
    • An exchange on for-profit healthcare
    • Gray, BH, ed. Washington, D.C.: National Academy Press
    • 5. Relman AS, Reinhardt U. An exchange on for-profit healthcare. In Gray, BH, ed. For-Profit Enterprise in Health Care. Washington, D.C.: National Academy Press, 1986:209-22.
    • (1986) For-profit Enterprise in Health Care , pp. 209-222
    • Relman, A.S.1    Reinhardt, U.2
  • 6
    • 0002113280 scopus 로고    scopus 로고
    • See note 2, American Medical Association 1995: 333
    • 6. See note 2, American Medical Association 1995: 333.
  • 7
    • 0028881271 scopus 로고    scopus 로고
    • Outcomes of hospital-based managed care: A multivariate analysis of cost and quality
    • 7. Blegen MA, Reiter RC, Goode CJ, et al. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstetrics & Gynecology 1995; 86:809-14; Braveman P, Schaaf VN, Egerter S, et al. Insurance related difference in the risk of ruptured appendix. New England Journal of Medicine 1994; 331:44-9; Carlyle DM, Siu AL, Keeler EB, et al. HMO vs. fee for service care for older persons with acute MI. American Journal of Public Health 1992; 82:1626-30; Langa KM, Susman EJ. The effect of cost containment policies on rates of coronary revascularization in California. New England Journal of Medicine 1993; 329:1784-9; Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA 1994; 271:1512-9; Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. American Journal of Public Health 1990; 80:411-5; Riley G, Potosky AL, Lubitz, JD, et al. Cancer stage at diagnosis for Medicare HMO and fee for service patients. American Journal of Public Health 1994; 84:1598-1604; Sisk JE, Gorman SA, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA 1996:276:50-5; Unvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for FFS and prepaid patients, Archives of Internal Medicine 1991;115:394-400; Ware JE, Rogers WH, Rose-Davies A, Goldberg GA, Newhouse JP, Brook RH, Keeler EB, et al. Comparison of health outcomes at an HMO with those of fee for service care. The Lancet 1986;1:1017-22. Underlying these criticisms is an important but often overlooked assumption, namely, that the economic reality of medicine qua business (including both its fee-for-service and managed care forms) is problematically at odds with the ideal standards of professional medical ethics (Agich GJ. Medicine as business and profession. Theoretical Medicine 1990;11:311-24.) The problem may rest less with managed care than with the underlying ethic of medicine that is strategically disconnected from the economic and social context of medical practice (Agich GJ. The importance of management for understanding managed care. Journal of Medicine and Philosophy 2000; in press). Thus the economic incentives attributed to managed care raise questions about the adequacy of some very deep assumptions about physician obligations, because managed care highlights what is a general role of economic interests of physicians to either increase or decrease services based on objectives other than patient welfare.
    • (1995) Obstetrics & Gynecology , vol.86 , pp. 809-814
    • Blegen, M.A.1    Reiter, R.C.2    Goode, C.J.3
  • 8
    • 0028111432 scopus 로고
    • Insurance related difference in the risk of ruptured appendix
    • 7. Blegen MA, Reiter RC, Goode CJ, et al. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstetrics & Gynecology 1995; 86:809-14; Braveman P, Schaaf VN, Egerter S, et al. Insurance related difference in the risk of ruptured appendix. New England Journal of Medicine 1994; 331:44-9; Carlyle DM, Siu AL, Keeler EB, et al. HMO vs. fee for service care for older persons with acute MI. American Journal of Public Health 1992; 82:1626-30; Langa KM, Susman EJ. The effect of cost containment policies on rates of coronary revascularization in California. New England Journal of Medicine 1993; 329:1784-9; Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA 1994; 271:1512-9; Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. American Journal of Public Health 1990; 80:411-5; Riley G, Potosky AL, Lubitz, JD, et al. Cancer stage at diagnosis for Medicare HMO and fee for service patients. American Journal of Public Health 1994; 84:1598-1604; Sisk JE, Gorman SA, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA 1996:276:50-5; Unvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for FFS and prepaid patients, Archives of Internal Medicine 1991;115:394-400; Ware JE, Rogers WH, Rose-Davies A, Goldberg GA, Newhouse JP, Brook RH, Keeler EB, et al. Comparison of health outcomes at an HMO with those of fee for service care. The Lancet 1986;1:1017-22. Underlying these criticisms is an important but often overlooked assumption, namely, that the economic reality of medicine qua business (including both its fee-for-service and managed care forms) is problematically at odds with the ideal standards of professional medical ethics (Agich GJ. Medicine as business and profession. Theoretical Medicine 1990;11:311-24.) The problem may rest less with managed care than with the underlying ethic of medicine that is strategically disconnected from the economic and social context of medical practice (Agich GJ. The importance of management for understanding managed care. Journal of Medicine and Philosophy 2000; in press). Thus the economic incentives attributed to managed care raise questions about the adequacy of some very deep assumptions about physician obligations, because managed care highlights what is a general role of economic interests of physicians to either increase or decrease services based on objectives other than patient welfare.
    • (1994) New England Journal of Medicine , vol.331 , pp. 44-49
    • Braveman, P.1    Schaaf, V.N.2    Egerter, S.3
  • 9
    • 0026471888 scopus 로고
    • HMO vs. Fee for service care for older persons with acute MI
    • 7. Blegen MA, Reiter RC, Goode CJ, et al. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstetrics & Gynecology 1995; 86:809-14; Braveman P, Schaaf VN, Egerter S, et al. Insurance related difference in the risk of ruptured appendix. New England Journal of Medicine 1994; 331:44-9; Carlyle DM, Siu AL, Keeler EB, et al. HMO vs. fee for service care for older persons with acute MI. American Journal of Public Health 1992; 82:1626-30; Langa KM, Susman EJ. The effect of cost containment policies on rates of coronary revascularization in California. New England Journal of Medicine 1993; 329:1784-9; Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA 1994; 271:1512-9; Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. American Journal of Public Health 1990; 80:411-5; Riley G, Potosky AL, Lubitz, JD, et al. Cancer stage at diagnosis for Medicare HMO and fee for service patients. American Journal of Public Health 1994; 84:1598-1604; Sisk JE, Gorman SA, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA 1996:276:50-5; Unvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for FFS and prepaid patients, Archives of Internal Medicine 1991;115:394-400; Ware JE, Rogers WH, Rose-Davies A, Goldberg GA, Newhouse JP, Brook RH, Keeler EB, et al. Comparison of health outcomes at an HMO with those of fee for service care. The Lancet 1986;1:1017-22. Underlying these criticisms is an important but often overlooked assumption, namely, that the economic reality of medicine qua business (including both its fee-for-service and managed care forms) is problematically at odds with the ideal standards of professional medical ethics (Agich GJ. Medicine as business and profession. Theoretical Medicine 1990;11:311-24.) The problem may rest less with managed care than with the underlying ethic of medicine that is strategically disconnected from the economic and social context of medical practice (Agich GJ. The importance of management for understanding managed care. Journal of Medicine and Philosophy 2000; in press). Thus the economic incentives attributed to managed care raise questions about the adequacy of some very deep assumptions about physician obligations, because managed care highlights what is a general role of economic interests of physicians to either increase or decrease services based on objectives other than patient welfare.
    • (1992) American Journal of Public Health , vol.82 , pp. 1626-1630
    • Carlyle, D.M.1    Siu, A.L.2    Keeler, E.B.3
  • 10
    • 0027431130 scopus 로고
    • The effect of cost containment policies on rates of coronary revascularization in California
    • 7. Blegen MA, Reiter RC, Goode CJ, et al. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstetrics & Gynecology 1995; 86:809-14; Braveman P, Schaaf VN, Egerter S, et al. Insurance related difference in the risk of ruptured appendix. New England Journal of Medicine 1994; 331:44-9; Carlyle DM, Siu AL, Keeler EB, et al. HMO vs. fee for service care for older persons with acute MI. American Journal of Public Health 1992; 82:1626-30; Langa KM, Susman EJ. The effect of cost containment policies on rates of coronary revascularization in California. New England Journal of Medicine 1993; 329:1784-9; Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA 1994; 271:1512-9; Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. American Journal of Public Health 1990; 80:411-5; Riley G, Potosky AL, Lubitz, JD, et al. Cancer stage at diagnosis for Medicare HMO and fee for service patients. American Journal of Public Health 1994; 84:1598-1604; Sisk JE, Gorman SA, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA 1996:276:50-5; Unvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for FFS and prepaid patients, Archives of Internal Medicine 1991;115:394-400; Ware JE, Rogers WH, Rose-Davies A, Goldberg GA, Newhouse JP, Brook RH, Keeler EB, et al. Comparison of health outcomes at an HMO with those of fee for service care. The Lancet 1986;1:1017-22. Underlying these criticisms is an important but often overlooked assumption, namely, that the economic reality of medicine qua business (including both its fee-for-service and managed care forms) is problematically at odds with the ideal standards of professional medical ethics (Agich GJ. Medicine as business and profession. Theoretical Medicine 1990;11:311-24.) The problem may rest less with managed care than with the underlying ethic of medicine that is strategically disconnected from the economic and social context of medical practice (Agich GJ. The importance of management for understanding managed care. Journal of Medicine and Philosophy 2000; in press). Thus the economic incentives attributed to managed care raise questions about the adequacy of some very deep assumptions about physician obligations, because managed care highlights what is a general role of economic interests of physicians to either increase or decrease services based on objectives other than patient welfare.
    • (1993) New England Journal of Medicine , vol.329 , pp. 1784-1789
    • Langa, K.M.1    Susman, E.J.2
  • 11
    • 84942950665 scopus 로고
    • Managed care plan performance since 1980: A literature analysis
    • 7. Blegen MA, Reiter RC, Goode CJ, et al. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstetrics & Gynecology 1995; 86:809-14; Braveman P, Schaaf VN, Egerter S, et al. Insurance related difference in the risk of ruptured appendix. New England Journal of Medicine 1994; 331:44-9; Carlyle DM, Siu AL, Keeler EB, et al. HMO vs. fee for service care for older persons with acute MI. American Journal of Public Health 1992; 82:1626-30; Langa KM, Susman EJ. The effect of cost containment policies on rates of coronary revascularization in California. New England Journal of Medicine 1993; 329:1784-9; Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA 1994; 271:1512-9; Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. American Journal of Public Health 1990; 80:411-5; Riley G, Potosky AL, Lubitz, JD, et al. Cancer stage at diagnosis for Medicare HMO and fee for service patients. American Journal of Public Health 1994; 84:1598-1604; Sisk JE, Gorman SA, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA 1996:276:50-5; Unvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for FFS and prepaid patients, Archives of Internal Medicine 1991;115:394-400; Ware JE, Rogers WH, Rose-Davies A, Goldberg GA, Newhouse JP, Brook RH, Keeler EB, et al. Comparison of health outcomes at an HMO with those of fee for service care. The Lancet 1986;1:1017-22. Underlying these criticisms is an important but often overlooked assumption, namely, that the economic reality of medicine qua business (including both its fee-for-service and managed care forms) is problematically at odds with the ideal standards of professional medical ethics (Agich GJ. Medicine as business and profession. Theoretical Medicine 1990;11:311-24.) The problem may rest less with managed care than with the underlying ethic of medicine that is strategically disconnected from the economic and social context of medical practice (Agich GJ. The importance of management for understanding managed care. Journal of Medicine and Philosophy 2000; in press). Thus the economic incentives attributed to managed care raise questions about the adequacy of some very deep assumptions about physician obligations, because managed care highlights what is a general role of economic interests of physicians to either increase or decrease services based on objectives other than patient welfare.
    • (1994) JAMA , vol.271 , pp. 1512-1519
    • Miller, R.H.1    Luft, H.S.2
  • 12
    • 0025219661 scopus 로고
    • The quality of ambulatory care in Medicare health maintenance organizations
    • 7. Blegen MA, Reiter RC, Goode CJ, et al. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstetrics & Gynecology 1995; 86:809-14; Braveman P, Schaaf VN, Egerter S, et al. Insurance related difference in the risk of ruptured appendix. New England Journal of Medicine 1994; 331:44-9; Carlyle DM, Siu AL, Keeler EB, et al. HMO vs. fee for service care for older persons with acute MI. American Journal of Public Health 1992; 82:1626-30; Langa KM, Susman EJ. The effect of cost containment policies on rates of coronary revascularization in California. New England Journal of Medicine 1993; 329:1784-9; Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA 1994; 271:1512-9; Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. American Journal of Public Health 1990; 80:411-5; Riley G, Potosky AL, Lubitz, JD, et al. Cancer stage at diagnosis for Medicare HMO and fee for service patients. American Journal of Public Health 1994; 84:1598-1604; Sisk JE, Gorman SA, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA 1996:276:50-5; Unvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for FFS and prepaid patients, Archives of Internal Medicine 1991;115:394-400; Ware JE, Rogers WH, Rose-Davies A, Goldberg GA, Newhouse JP, Brook RH, Keeler EB, et al. Comparison of health outcomes at an HMO with those of fee for service care. The Lancet 1986;1:1017-22. Underlying these criticisms is an important but often overlooked assumption, namely, that the economic reality of medicine qua business (including both its fee-for-service and managed care forms) is problematically at odds with the ideal standards of professional medical ethics (Agich GJ. Medicine as business and profession. Theoretical Medicine 1990;11:311-24.) The problem may rest less with managed care than with the underlying ethic of medicine that is strategically disconnected from the economic and social context of medical practice (Agich GJ. The importance of management for understanding managed care. Journal of Medicine and Philosophy 2000; in press). Thus the economic incentives attributed to managed care raise questions about the adequacy of some very deep assumptions about physician obligations, because managed care highlights what is a general role of economic interests of physicians to either increase or decrease services based on objectives other than patient welfare.
    • (1990) American Journal of Public Health , vol.80 , pp. 411-415
    • Retchin, S.M.1    Brown, B.2
  • 13
    • 0028061846 scopus 로고
    • Cancer stage at diagnosis for medicare HMO and fee for service patients
    • 7. Blegen MA, Reiter RC, Goode CJ, et al. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstetrics & Gynecology 1995; 86:809-14; Braveman P, Schaaf VN, Egerter S, et al. Insurance related difference in the risk of ruptured appendix. New England Journal of Medicine 1994; 331:44-9; Carlyle DM, Siu AL, Keeler EB, et al. HMO vs. fee for service care for older persons with acute MI. American Journal of Public Health 1992; 82:1626-30; Langa KM, Susman EJ. The effect of cost containment policies on rates of coronary revascularization in California. New England Journal of Medicine 1993; 329:1784-9; Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA 1994; 271:1512-9; Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. American Journal of Public Health 1990; 80:411-5; Riley G, Potosky AL, Lubitz, JD, et al. Cancer stage at diagnosis for Medicare HMO and fee for service patients. American Journal of Public Health 1994; 84:1598-1604; Sisk JE, Gorman SA, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA 1996:276:50-5; Unvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for FFS and prepaid patients, Archives of Internal Medicine 1991;115:394-400; Ware JE, Rogers WH, Rose-Davies A, Goldberg GA, Newhouse JP, Brook RH, Keeler EB, et al. Comparison of health outcomes at an HMO with those of fee for service care. The Lancet 1986;1:1017-22. Underlying these criticisms is an important but often overlooked assumption, namely, that the economic reality of medicine qua business (including both its fee-for-service and managed care forms) is problematically at odds with the ideal standards of professional medical ethics (Agich GJ. Medicine as business and profession. Theoretical Medicine 1990;11:311-24.) The problem may rest less with managed care than with the underlying ethic of medicine that is strategically disconnected from the economic and social context of medical practice (Agich GJ. The importance of management for understanding managed care. Journal of Medicine and Philosophy 2000; in press). Thus the economic incentives attributed to managed care raise questions about the adequacy of some very deep assumptions about physician obligations, because managed care highlights what is a general role of economic interests of physicians to either increase or decrease services based on objectives other than patient welfare.
    • (1994) American Journal of Public Health , vol.84 , pp. 1598-1604
    • Riley, G.1    Potosky, A.L.2    Lubitz, J.D.3
  • 14
    • 0029957884 scopus 로고    scopus 로고
    • Evaluation of Medicaid managed care: Satisfaction, access, and use
    • 7. Blegen MA, Reiter RC, Goode CJ, et al. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstetrics & Gynecology 1995; 86:809-14; Braveman P, Schaaf VN, Egerter S, et al. Insurance related difference in the risk of ruptured appendix. New England Journal of Medicine 1994; 331:44-9; Carlyle DM, Siu AL, Keeler EB, et al. HMO vs. fee for service care for older persons with acute MI. American Journal of Public Health 1992; 82:1626-30; Langa KM, Susman EJ. The effect of cost containment policies on rates of coronary revascularization in California. New England Journal of Medicine 1993; 329:1784-9; Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA 1994; 271:1512-9; Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. American Journal of Public Health 1990; 80:411-5; Riley G, Potosky AL, Lubitz, JD, et al. Cancer stage at diagnosis for Medicare HMO and fee for service patients. American Journal of Public Health 1994; 84:1598-1604; Sisk JE, Gorman SA, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA 1996:276:50-5; Unvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for FFS and prepaid patients, Archives of Internal Medicine 1991;115:394-400; Ware JE, Rogers WH, Rose-Davies A, Goldberg GA, Newhouse JP, Brook RH, Keeler EB, et al. Comparison of health outcomes at an HMO with those of fee for service care. The Lancet 1986;1:1017-22. Underlying these criticisms is an important but often overlooked assumption, namely, that the economic reality of medicine qua business (including both its fee-for-service and managed care forms) is problematically at odds with the ideal standards of professional medical ethics (Agich GJ. Medicine as business and profession. Theoretical Medicine 1990;11:311-24.) The problem may rest less with managed care than with the underlying ethic of medicine that is strategically disconnected from the economic and social context of medical practice (Agich GJ. The importance of management for understanding managed care. Journal of Medicine and Philosophy 2000; in press). Thus the economic incentives attributed to managed care raise questions about the adequacy of some very deep assumptions about physician obligations, because managed care highlights what is a general role of economic interests of physicians to either increase or decrease services based on objectives other than patient welfare.
    • (1996) JAMA , vol.276 , pp. 50-55
    • Sisk, J.E.1    Gorman, S.A.2
  • 15
    • 0025779677 scopus 로고
    • Comparison of the quality of ambulatory care for FFS and prepaid patients
    • 7. Blegen MA, Reiter RC, Goode CJ, et al. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstetrics & Gynecology 1995; 86:809-14; Braveman P, Schaaf VN, Egerter S, et al. Insurance related difference in the risk of ruptured appendix. New England Journal of Medicine 1994; 331:44-9; Carlyle DM, Siu AL, Keeler EB, et al. HMO vs. fee for service care for older persons with acute MI. American Journal of Public Health 1992; 82:1626-30; Langa KM, Susman EJ. The effect of cost containment policies on rates of coronary revascularization in California. New England Journal of Medicine 1993; 329:1784-9; Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA 1994; 271:1512-9; Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. American Journal of Public Health 1990; 80:411-5; Riley G, Potosky AL, Lubitz, JD, et al. Cancer stage at diagnosis for Medicare HMO and fee for service patients. American Journal of Public Health 1994; 84:1598-1604; Sisk JE, Gorman SA, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA 1996:276:50-5; Unvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for FFS and prepaid patients, Archives of Internal Medicine 1991;115:394-400; Ware JE, Rogers WH, Rose-Davies A, Goldberg GA, Newhouse JP, Brook RH, Keeler EB, et al. Comparison of health outcomes at an HMO with those of fee for service care. The Lancet 1986;1:1017-22. Underlying these criticisms is an important but often overlooked assumption, namely, that the economic reality of medicine qua business (including both its fee-for-service and managed care forms) is problematically at odds with the ideal standards of professional medical ethics (Agich GJ. Medicine as business and profession. Theoretical Medicine 1990;11:311-24.) The problem may rest less with managed care than with the underlying ethic of medicine that is strategically disconnected from the economic and social context of medical practice (Agich GJ. The importance of management for understanding managed care. Journal of Medicine and Philosophy 2000; in press). Thus the economic incentives attributed to managed care raise questions about the adequacy of some very deep assumptions about physician obligations, because managed care highlights what is a general role of economic interests of physicians to either increase or decrease services based on objectives other than patient welfare.
    • (1991) Archives of Internal Medicine , vol.115 , pp. 394-400
    • Unvarhelyi, I.S.1    Jennison, K.2    Phillips, R.S.3    Epstein, A.M.4
  • 16
    • 0022601251 scopus 로고
    • Comparison of health outcomes at an HMO with those of fee for service care
    • 7. Blegen MA, Reiter RC, Goode CJ, et al. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstetrics & Gynecology 1995; 86:809-14; Braveman P, Schaaf VN, Egerter S, et al. Insurance related difference in the risk of ruptured appendix. New England Journal of Medicine 1994; 331:44-9; Carlyle DM, Siu AL, Keeler EB, et al. HMO vs. fee for service care for older persons with acute MI. American Journal of Public Health 1992; 82:1626-30; Langa KM, Susman EJ. The effect of cost containment policies on rates of coronary revascularization in California. New England Journal of Medicine 1993; 329:1784-9; Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA 1994; 271:1512-9; Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. American Journal of Public Health 1990; 80:411-5; Riley G, Potosky AL, Lubitz, JD, et al. Cancer stage at diagnosis for Medicare HMO and fee for service patients. American Journal of Public Health 1994; 84:1598-1604; Sisk JE, Gorman SA, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA 1996:276:50-5; Unvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for FFS and prepaid patients, Archives of Internal Medicine 1991;115:394-400; Ware JE, Rogers WH, Rose-Davies A, Goldberg GA, Newhouse JP, Brook RH, Keeler EB, et al. Comparison of health outcomes at an HMO with those of fee for service care. The Lancet 1986;1:1017-22. Underlying these criticisms is an important but often overlooked assumption, namely, that the economic reality of medicine qua business (including both its fee-for-service and managed care forms) is problematically at odds with the ideal standards of professional medical ethics (Agich GJ. Medicine as business and profession. Theoretical Medicine 1990;11:311-24.) The problem may rest less with managed care than with the underlying ethic of medicine that is strategically disconnected from the economic and social context of medical practice (Agich GJ. The importance of management for understanding managed care. Journal of Medicine and Philosophy 2000; in press). Thus the economic incentives attributed to managed care raise questions about the adequacy of some very deep assumptions about physician obligations, because managed care highlights what is a general role of economic interests of physicians to either increase or decrease services based on objectives other than patient welfare.
    • (1986) The Lancet , vol.1 , pp. 1017-1022
    • Ware, J.E.1    Rogers, W.H.2    Rose-Davies, A.3    Goldberg, G.A.4    Newhouse, J.P.5    Brook, R.H.6    Keeler, E.B.7
  • 17
    • 0025611316 scopus 로고
    • Medicine as business and profession
    • 7. Blegen MA, Reiter RC, Goode CJ, et al. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstetrics & Gynecology 1995; 86:809-14; Braveman P, Schaaf VN, Egerter S, et al. Insurance related difference in the risk of ruptured appendix. New England Journal of Medicine 1994; 331:44-9; Carlyle DM, Siu AL, Keeler EB, et al. HMO vs. fee for service care for older persons with acute MI. American Journal of Public Health 1992; 82:1626-30; Langa KM, Susman EJ. The effect of cost containment policies on rates of coronary revascularization in California. New England Journal of Medicine 1993; 329:1784-9; Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA 1994; 271:1512-9; Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. American Journal of Public Health 1990; 80:411-5; Riley G, Potosky AL, Lubitz, JD, et al. Cancer stage at diagnosis for Medicare HMO and fee for service patients. American Journal of Public Health 1994; 84:1598-1604; Sisk JE, Gorman SA, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA 1996:276:50-5; Unvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for FFS and prepaid patients, Archives of Internal Medicine 1991;115:394-400; Ware JE, Rogers WH, Rose-Davies A, Goldberg GA, Newhouse JP, Brook RH, Keeler EB, et al. Comparison of health outcomes at an HMO with those of fee for service care. The Lancet 1986;1:1017-22. Underlying these criticisms is an important but often overlooked assumption, namely, that the economic reality of medicine qua business (including both its fee-for-service and managed care forms) is problematically at odds with the ideal standards of professional medical ethics (Agich GJ. Medicine as business and profession. Theoretical Medicine 1990;11:311-24.) The problem may rest less with managed care than with the underlying ethic of medicine that is strategically disconnected from the economic and social context of medical practice (Agich GJ. The importance of management for understanding managed care. Journal of Medicine and Philosophy 2000; in press). Thus the economic incentives attributed to managed care raise questions about the adequacy of some very deep assumptions about physician obligations, because managed care highlights what is a general role of economic interests of physicians to either increase or decrease services based on objectives other than patient welfare.
    • (1990) Theoretical Medicine , vol.11 , pp. 311-324
    • Agich, G.J.1
  • 18
    • 0028881271 scopus 로고    scopus 로고
    • The importance of management for understanding managed care
    • in press
    • 7. Blegen MA, Reiter RC, Goode CJ, et al. Outcomes of hospital-based managed care: a multivariate analysis of cost and quality. Obstetrics & Gynecology 1995; 86:809-14; Braveman P, Schaaf VN, Egerter S, et al. Insurance related difference in the risk of ruptured appendix. New England Journal of Medicine 1994; 331:44-9; Carlyle DM, Siu AL, Keeler EB, et al. HMO vs. fee for service care for older persons with acute MI. American Journal of Public Health 1992; 82:1626-30; Langa KM, Susman EJ. The effect of cost containment policies on rates of coronary revascularization in California. New England Journal of Medicine 1993; 329:1784-9; Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis. JAMA 1994; 271:1512-9; Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. American Journal of Public Health 1990; 80:411-5; Riley G, Potosky AL, Lubitz, JD, et al. Cancer stage at diagnosis for Medicare HMO and fee for service patients. American Journal of Public Health 1994; 84:1598-1604; Sisk JE, Gorman SA, et al. Evaluation of Medicaid managed care: satisfaction, access, and use. JAMA 1996:276:50-5; Unvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for FFS and prepaid patients, Archives of Internal Medicine 1991;115:394-400; Ware JE, Rogers WH, Rose-Davies A, Goldberg GA, Newhouse JP, Brook RH, Keeler EB, et al. Comparison of health outcomes at an HMO with those of fee for service care. The Lancet 1986;1:1017-22. Underlying these criticisms is an important but often overlooked assumption, namely, that the economic reality of medicine qua business (including both its fee-for-service and managed care forms) is problematically at odds with the ideal standards of professional medical ethics (Agich GJ. Medicine as business and profession. Theoretical Medicine 1990;11:311-24.) The problem may rest less with managed care than with the underlying ethic of medicine that is strategically disconnected from the economic and social context of medical practice (Agich GJ. The importance of management for understanding managed care. Journal of Medicine and Philosophy 2000; in press). Thus the economic incentives attributed to managed care raise questions about the adequacy of some very deep assumptions about physician obligations, because managed care highlights what is a general role of economic interests of physicians to either increase or decrease services based on objectives other than patient welfare.
    • (2000) Journal of Medicine and Philosophy
    • Agich, G.J.1
  • 19
    • 0032481573 scopus 로고    scopus 로고
    • Selection and exclusion of primary care physicians by managed care organizations
    • 8. Bindman AB, Grumback K, Vranizan K, Jaffe D, Osmond D. Selection and exclusion of primary care physicians by managed care organizations. JAMA 1998; 279:675-9.
    • (1998) JAMA , vol.279 , pp. 675-679
    • Bindman, A.B.1    Grumback, K.2    Vranizan, K.3    Jaffe, D.4    Osmond, D.5
  • 20
    • 0002102059 scopus 로고    scopus 로고
    • See note 1, Kassirer 1995:50
    • 9. See note 1, Kassirer 1995:50.
  • 21
    • 0030776787 scopus 로고    scopus 로고
    • Managed care regulation: In the laboratory of the states
    • 10. Miller TE. Managed care regulation: in the laboratory of the states. JAMA 1997;278:1102-9.
    • (1997) Jama , vol.278 , pp. 1102-1109
    • Miller, T.E.1
  • 22
    • 0002260415 scopus 로고    scopus 로고
    • See note 10, Miller 1997:1107
    • 11. See note 10, Miller 1997:1107.
  • 23
    • 0030076786 scopus 로고    scopus 로고
    • Teaching residents about managed care
    • 12. Tinsley JA. Teaching residents about managed care. Mayo Clinic Proceedings 1996; 71:201-4.
    • (1996) Mayo Clinic Proceedings , vol.71 , pp. 201-204
    • Tinsley, J.A.1
  • 24
    • 84990342364 scopus 로고    scopus 로고
    • Miss treatment
    • Dec.
    • 13. Reed SE. Miss treatment. New Republic 1997;Dec. 29:20-2.
    • (1997) New Republic , vol.29 , pp. 20-22
    • Reed, S.E.1
  • 25
    • 0002292736 scopus 로고    scopus 로고
    • See note 13, Reed 1997:20
    • 14. See note 13, Reed 1997:20.
  • 26
    • 0002251070 scopus 로고    scopus 로고
    • Texas will allow malpractice suits against HMOs
    • June 5
    • 15. Verhovek S. Texas will allow malpractice suits against HMOs. New York Times 1997; June 5.
    • (1997) New York Times
    • Verhovek, S.1
  • 27
    • 0002298705 scopus 로고    scopus 로고
    • note
    • 16. Of course, it might be said that many patients do not themselves choose managed care over indemnity health insurance. The choice is made by their employer or the government. However, from the point view of autonomy, these patients are not prohibited from choosing additional indemnity coverage; they are constrained, to be sure, but by their own inability or unwillingness to pay, not by managed care as such.
  • 28
    • 0002113282 scopus 로고
    • Access to health care: Charity and rights
    • Bole TJ, Bondeson WB, eds. Dordrecht: Kluwer Academic Publishers
    • 17. Agich GJ. Access to health care: charity and rights. In: Bole TJ, Bondeson WB, eds. Rights to Health Care. Dordrecht: Kluwer Academic Publishers 1991:185-98; Halper T. Rights, reforms, and the health care crisis: problems and prospects. In: Bole, Bondeson, 1991:135-68; Marmor T. The right to health care: reflections on its history and politics. In: Bole, Bondeson 1991:23-49.
    • (1991) Rights to Health Care , pp. 185-198
    • Agich, G.J.1
  • 29
    • 0347552791 scopus 로고
    • Bole, Bondeson
    • 17. Agich GJ. Access to health care: charity and rights. In: Bole TJ, Bondeson WB, eds. Rights to Health Care. Dordrecht: Kluwer Academic Publishers 1991:185-98; Halper T. Rights, reforms, and the health care crisis: problems and prospects. In: Bole, Bondeson, 1991:135-68; Marmor T. The right to health care: reflections on its history and politics. In: Bole, Bondeson 1991:23-49.
    • (1991) Rights, Reforms, and the Health Care Crisis: Problems and Prospects , pp. 135-168
    • Halper, T.1
  • 30
    • 0002113284 scopus 로고
    • Bole, Bondeson
    • 17. Agich GJ. Access to health care: charity and rights. In: Bole TJ, Bondeson WB, eds. Rights to Health Care. Dordrecht: Kluwer Academic Publishers 1991:185-98; Halper T. Rights, reforms, and the health care crisis: problems and prospects. In: Bole, Bondeson, 1991:135-68; Marmor T. The right to health care: reflections on its history and politics. In: Bole, Bondeson 1991:23-49.
    • (1991) The Right to Health Care: Reflections on Its History and Politics , pp. 23-49
    • Marmor, T.1
  • 31
    • 0002294336 scopus 로고    scopus 로고
    • See note 2, American Medical Association 1995:333
    • 18. See note 2, American Medical Association 1995:333.
  • 32
    • 0028869742 scopus 로고
    • Preserving the physician-patient relationship in the era of managed care
    • 19. Emanuel EJ, Dubler NN. Preserving the physician-patient relationship in the era of managed care. JAMA 1995;273:323-9.
    • (1995) JAMA , vol.273 , pp. 323-329
    • Emanuel, E.J.1    Dubler, N.N.2
  • 33
    • 0027210029 scopus 로고
    • Managed competition and the patient-physician relationship
    • 20. Emanuel EJ, Brett A. Managed competition and the patient-physician relationship. New England Journal of Medicine 1993;329:879-82.
    • (1993) New England Journal of Medicine , vol.329 , pp. 879-882
    • Emanuel, E.J.1    Brett, A.2
  • 35
    • 0002383350 scopus 로고    scopus 로고
    • See note 21, Austad, Hunter, Morgan 1998
    • 22. See note 21, Austad, Hunter, Morgan 1998.
  • 36
    • 0002095445 scopus 로고    scopus 로고
    • note
    • 23. In making this point, we ignore the fact that some MCOs are not direct healthcare providers, but are administrative entities that provide healthcare insurance or organize healthcare providers and negotiate contracts with employers and insurers.
  • 37
    • 0002098033 scopus 로고    scopus 로고
    • note
    • 24. None of the foregoing addresses other, possibly more significant problems associated with managed care. For example, managed care companies may target young and healthy patients (cream-skimming) whom they expect will use fewer services and exclude more needy patients.
  • 38
    • 0002383352 scopus 로고    scopus 로고
    • note
    • 25. An obvious objection is that malpractice provides an important system of accountability. This observation deserves two brief comments. First, the accountability introduced is ab extra and retrospective. Second, because it is based on the negligence standard that relies on the standard of care assessment, malpractice cannot do much to actually improve quality of care. It is designed to identify and provide compensation for deviations from a standard of care, not establish the standard itself; physicians and other health providers establish the standard. One other goal of malpractice, namely, retribution, has been marginalized, if not eliminated, as punitive damages have been limited or eliminated in many states by so-called tort law reform.
  • 39
    • 0031607122 scopus 로고    scopus 로고
    • Partnerships for research among managed care organizations
    • 26. Durham ML. Partnerships for research among managed care organizations. Health Affairs 1998;17:111-22; Eisenberg JM. Health services research in a market-oriented health care system. Health Affairs 1998;17:98-110; Gabel JR. On drinking with your competitors after five: research collaboration in the world. Health Affairs 1998;17:123-7; Nelson AF, Quiter ES, Solberg LI. The state of research within managed care plans: 1997 survey. Health Affairs 1998;17:128-38.
    • (1998) Health Affairs , vol.17 , pp. 111-122
    • Durham, M.L.1
  • 40
    • 0031606136 scopus 로고    scopus 로고
    • Health services research in a market-oriented health care system
    • 26. Durham ML. Partnerships for research among managed care organizations. Health Affairs 1998;17:111-22; Eisenberg JM. Health services research in a market-oriented health care system. Health Affairs 1998;17:98-110; Gabel JR. On drinking with your competitors after five: research collaboration in the world. Health Affairs 1998;17:123-7; Nelson AF, Quiter ES, Solberg LI. The state of research within managed care plans: 1997 survey. Health Affairs 1998;17:128-38.
    • (1998) Health Affairs , vol.17 , pp. 98-110
    • Eisenberg, J.M.1
  • 41
    • 0031600655 scopus 로고    scopus 로고
    • On drinking with your competitors after five: Research collaboration in the world
    • 26. Durham ML. Partnerships for research among managed care organizations. Health Affairs 1998;17:111-22; Eisenberg JM. Health services research in a market-oriented health care system. Health Affairs 1998;17:98-110; Gabel JR. On drinking with your competitors after five: research collaboration in the world. Health Affairs 1998;17:123-7; Nelson AF, Quiter ES, Solberg LI. The state of research within managed care plans: 1997 survey. Health Affairs 1998;17:128-38.
    • (1998) Health Affairs , vol.17 , pp. 123-127
    • Gabel, J.R.1
  • 42
    • 0031607976 scopus 로고    scopus 로고
    • The state of research within managed care plans: 1997 survey
    • 26. Durham ML. Partnerships for research among managed care organizations. Health Affairs 1998;17:111-22; Eisenberg JM. Health services research in a market-oriented health care system. Health Affairs 1998;17:98-110; Gabel JR. On drinking with your competitors after five: research collaboration in the world. Health Affairs 1998;17:123-7; Nelson AF, Quiter ES, Solberg LI. The state of research within managed care plans: 1997 survey. Health Affairs 1998;17:128-38.
    • (1998) Health Affairs , vol.17 , pp. 128-138
    • Nelson, A.F.1    Quiter, E.S.2    Solberg, L.I.3
  • 43
    • 0029367649 scopus 로고
    • Ethically important distinctions among managed care organizations
    • 27. Christensen KT. Ethically important distinctions among managed care organizations. Journal of Law, Medicine & Ethics 1995;23:223-9; Clancy DM, Brody H. Managed care: Jekyll or Hyde? JAMA 1995;273:338-9.
    • (1995) Journal of Law, Medicine & Ethics , vol.23 , pp. 223-229
    • Christensen, K.T.1
  • 44
    • 0028859873 scopus 로고
    • Managed care: Jekyll or Hyde?
    • 27. Christensen KT. Ethically important distinctions among managed care organizations. Journal of Law, Medicine & Ethics 1995;23:223-9; Clancy DM, Brody H. Managed care: Jekyll or Hyde? JAMA 1995;273:338-9.
    • (1995) JAMA , vol.273 , pp. 338-339
    • Clancy, D.M.1    Brody, H.2
  • 45
    • 0002251072 scopus 로고    scopus 로고
    • See note 7, Agich 2000
    • 28. See note 7, Agich 2000.
  • 46
    • 0029449285 scopus 로고
    • Comments on the AMA Report "Ethical Issues in Managed Care."
    • 29. Miles SH, Koepp R. Comments on the AMA Report "Ethical Issues in Managed Care." Journal of Clinical Ethics 1995; 6:306-11.
    • (1995) Journal of Clinical Ethics , vol.6 , pp. 306-311
    • Miles, S.H.1    Koepp, R.2
  • 47
    • 0028541668 scopus 로고
    • The ethical life of health care organizations
    • 30. Reiser SJ. The ethical life of health care organizations. Hastings Center Report 1994;24(6):28-35.
    • (1994) Hastings Center Report , vol.24 , Issue.6 , pp. 28-35
    • Reiser, S.J.1
  • 49
    • 0002362881 scopus 로고    scopus 로고
    • See note 27, Christensen 1995
    • 32. See note 27, Christensen 1995.
  • 50
    • 0002362883 scopus 로고    scopus 로고
    • See note 7, Agich 200
    • 33. See note 7, Agich 200.
  • 51
    • 0030717516 scopus 로고    scopus 로고
    • Managed care is not the problem, quality is
    • 34. Brook RH. Managed care is not the problem, quality is. JAMA 1997;278:1612-4.
    • (1997) JAMA , vol.278 , pp. 1612-1614
    • Brook, R.H.1
  • 52
    • 0343901149 scopus 로고    scopus 로고
    • Trust and trustworthy care in the managed care era
    • 35. Gray BH. Trust and trustworthy care in the managed care era. Health Affairs 1997;16:34-47;
    • (1997) Health Affairs , vol.16 , pp. 34-47
    • Gray, B.H.1
  • 53
    • 0345908341 scopus 로고    scopus 로고
    • Measures of trust in health care
    • Newcomer, LN. Measures of trust in health care. Health Affairs 1997;16:50-1.
    • (1997) Health Affairs , vol.16 , pp. 50-51
    • Newcomer, L.N.1
  • 54
    • 0003561014 scopus 로고
    • New York: Oxford University Press
    • 36. Menzel PT. Strong Medicine: The Ethical Rationing of Health Care. New York: Oxford University Press, 1990; Menzel PT. Some ethical costs of rationing. Law, Medicine & Health Care 1992;20:56-66; Menzel PT. Double agency and the ethics of rationing health care: a response to Marcia Angell. Kennedy Institute of Ethics Journal 1993;3:287-92.
    • (1990) Strong Medicine: The Ethical Rationing of Health Care
    • Menzel, P.T.1
  • 55
    • 85053485774 scopus 로고
    • Some ethical costs of rationing
    • 36. Menzel PT. Strong Medicine: The Ethical Rationing of Health Care. New York: Oxford University Press, 1990; Menzel PT. Some ethical costs of rationing. Law, Medicine & Health Care 1992;20:56-66; Menzel PT. Double agency and the ethics of rationing health care: a response to Marcia Angell. Kennedy Institute of Ethics Journal 1993;3:287-92.
    • (1992) Law, Medicine & Health Care , vol.20 , pp. 56-66
  • 56
    • 0027670677 scopus 로고
    • Double agency and the ethics of rationing health care: A response to Marcia Angell
    • 36. Menzel PT. Strong Medicine: The Ethical Rationing of Health Care. New York: Oxford University Press, 1990; Menzel PT. Some ethical costs of rationing. Law, Medicine & Health Care 1992;20:56-66; Menzel PT. Double agency and the ethics of rationing health care: a response to Marcia Angell. Kennedy Institute of Ethics Journal 1993;3:287-92.
    • (1993) Kennedy Institute of Ethics Journal , vol.3 , pp. 287-292
    • Menzel, P.T.1
  • 57
    • 0002334527 scopus 로고    scopus 로고
    • See note 27, Christensen 1995
    • 37. See note 27, Christensen 1995.
  • 58
    • 0002389497 scopus 로고    scopus 로고
    • See note 36, Menzel 1990; Menzel 1992
    • 38. 38 See note 36, Menzel 1990; Menzel 1992.
  • 60
    • 0003497867 scopus 로고
    • Washington, D.C.: U.S. Government Printing Office, 1985
    • 40. Critics of our view might point out that the inflation in medical care costs especially during the 1970s and early 1980s was part of a larger and significant inflation. It is true that costs of all goods and services increased at dramatic and alarming rates during the 1970s and early 1980s, but during this period medical care costs as measured by the Medical Consumer Price Index (MCPI), which is a component of the better-known Consumer Price Index (CPI), had a higher rate of growth than the CPI (U.S. Department of Health and Human Services. Health United States 1985. Washington, D.C.: U.S. Government Printing Office, 1985.
    • (1985) Health United States


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