Managed care seeks to provide the right care, at the right time, in the right amount. How should ethics influence leadership decision making so patients will be able to receive the care they need versus the care they want?
Managed care is an attempt to reduce costs and improve outcomes through the elimination of redundancies and other inefficiencies. Both the patient and physician may be offered financial incentives for choosing less costly procedures or reducing the length of hospital stays. To many, management techniques to improve efficiency and effectiveness may sound a lot like healthcare rationing. The U.S. spends an enormous amount on healthcare (Gruenewald, 20120). Despite this, Americans are among the least healthy of industrial nations (Insel & Roth, 2009). It is clear that healthcare spending and healthcare practices need to be reformed and rethought. Americans need to become more accountable for their choices and behaviors (smoking, poor diet, lack of exercise) that lead to poor health and additional strain on the healthcare system. People understand the theories behind managed care, but are not usually willing to abide by the theory when it comes to their own care.
The need to balance the patients wants and needs with cost and efficiency can lead to ethical dilemmas for the healthcare leader. Leaders in the healthcare industry must balance management practices with ethical care. Leaders, in any industry, must be guided by firm values and clear organizational goals. Sometimes ethical values can seem to contradict cost saving and efficiency goals. Whatever choices the leader makes, they should be guided by ethical standards. This is even more important in the healthcare field. For me, who has spent seventeen years in a public health agency, I cannot make decisions or choices that go against my own personal values and ethical standards. For instance, if I wouldn't use the services offered in a public health clinic, then I shouldn't offer those services in my community. The bottom line is, in healthcare, decisions cannot be made based on cost alone. Decisions should be made following a firm ethical standard; grounded in integrity and humanity. Quality of care is critical. A patient's healthcare should not be short cut due to cost cutting. This is why healthcare organizations, especially managed care organizations, should consider having a written code of ethics that everyone follows, especially leaders and decision-makers. It won't remove the hard choices, but it will provide a framework for making good, ethical decisions. Having said all of this about a firm code of ethics and quality of care, fiscal responsibility is also important. It goes back to balance. The managed care leader must balance cost with ethical care.
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Ethical leadership in managed care and the healthcare setting.