Patients lament that managed care does not fulfill its fiduciary duty of establishing a meaningful patient-physician relationship. This explains the decrease in trust of the patients towards managed care because of the small period of time that physicians spend with them discussing their problems and exploring treatment options thereby affecting the development of a meaningful relationship between the two parties.
This is especially depicted in managed care programs that run fee-for-service payment schemes (Jecker & Braddock para. 4).
Moreover, patients blame managed care for the provision of lower quality of health care because of the limitation they impose that prevent patients from visiting other physicians that are not registers members of managed care panel.
This further undermines the possibility for development of a profound relationship between the patient and physicians of their choices. This is because patients who wish to seek health care services from other physicians outside the panel list have to pay an extra amount for the provision of health care. Managed care organizations that use physicians as gatekeepers to authorize patients to visit medical specialists are mostly associated with provision of lower quality of health care delivery systems (Weber 56-57).
Furthermore, the patients’ advocacy is compromised by the physicians in their attempt of securing the economic incentives promised to them by managed care organizations. Physicians aim at running cost-effective health care which is achieved by spending less time with the patients, providing medicines that are less costly and implementing fewer costly diagnostic tests and treatment services.
This helps physicians to run cost saving health care facilities thereby incapacitating their adherence to nursing and moral ethics (Gal ; Doron 158-163).
Health Care Laws
The contract between the physician and managed care organization contains a Gag Clause that prevents the physician from educating or discussing with the patient other medical care services that are against the principles of managed care organization (MOC) because they are perceived as expensive and in most instances are not insured.
The concern raised by patients and ethicists led to the implementation of the Anti-gag Clause to help improve the relationship between the physicians and their patients by encouraging the two parties to communicate more thus deeply discussing the problems of patients’ in contrast to the principles of managed care which allows physicians to spend less time with their patients thus limiting the evaluation of many diagnostic and treatment options especially the expensive ones that can be helpful to the patients and maybe save their lives.
Although it overly improves the quality of health care because of the uplifted efficiency of medical practitioners, the clause fails to increase the trust that patients have in the medical practitioners. Moreover, the contracts binding the physicians and MOC’s contain a termination-without-cause clause thus allowing the organizations to fire physicians who defy their principles without explanations. Furthermore, this clause is under a threat of termination by the state legislature and Congress (Kronebusch 219-259).
Any Willing Provider (AWP) law was enacted in the 1980’s by the network of providers who perpetuated managed care. The law guides the contract that stipulates the principles required by health practitioners when they become panel members.
This law allows any physician who has agreed to work by the contractual terms to be a member of the managed care network organization. It is argued that the law gives patients a wide variety of physicians to choose from, helps pharmacies and small health care centers to survive in the stiff market competition and reduces patients travel time. However, insurers are against the law because it increases their administrative costs and does not give them amble time to negotiate with the patients on lower terms of payment.
They also argue that this law reduces the quality of health care because the efficiency of the physicians is lowered. Furthermore, conducted research and studied show that this law increases the general cost of health maintenance organizations (HMO’s) (Kronebusch 219-259).
Employee Retirement Income Security Act (ERISA) was enacted in 1978 by the federal government to set minimum conditions for any pension and health plan formulated in a private sector thus protecting the stakeholders.
This is because the law mandates that the stakeholders should be availed with all the plans and contractual information, the fiduciary responsibilities and the regulations that require to be fulfilled before appealing for their benefits. This law also gives the stakeholders the right to sue if they suspect or witness any act against the fiduciary responsibilities or breach onto the agreement of receiving their benefits (Schultz para. 1-3).
However, the law only protects stakeholders in the private sector and does not protect health care practitioners working in Hawaii because the Hawaii Prepaid Health Care Act that was enacted before ERISA does not recognize the regulations stipulated in ERISA law and thus cannot amend the Hawaii Prepaid Health Care Act, though their provision of amending the law if Congress agrees.
This law has been re-evaluated leading to the incorporation of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) which allows employees and their family members to continue seeking health care for a limited period of time in the event of losing their employment among other catastrophic events, the Newborns’ and Mothers’ Health Protection Act, the Women’s Health and Cancer Rights Act, the Mental Health Parity Act and the Health Insurance Portability and Accountability Act (HIPAA) of 1996 which improved the efficiency of private health care delivery systems by making its coverage more portable and safe for employees to access among others (Schultz para. 1-3).
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Gal, I. and Doron, I. “Informal complaints on health services: hidden patterns, hidden potentials”. International Journal Quality Health Care 19 (2002): 158-163.
Jecker, Nancy and Braddock, Clarence. “Managed care”. Medical History and Ethics, University of Washington (2008). 3rd, June, 2009. <http://depts.washington.edu/bioethx/topics/manag.html>.
Kronebusch, K., Schlesinger, M. and Thomas, T. “Managed Care Regulation in the States: The Impact on Physicians’ Practices and Clinical Autonomy”. Journal of Health Politics Policy and Law 34.2 (2009): 219-259.
Schultz, Ellen. “Companies Sue Union Retirees To Cut Promised Health Benefits”. The Wall Street Journal (2004). 3rd, June, 2009. ;http://online.wsj.com/public/resources/documents/SB110003711129469246.htm;.
Weber, Leonard. Business Ethics in Health Care: Beyond Compliance. Indiana: Indiana University Press, 2001.