The writers attempt to analyze the principle structures of the managed care system in an effort to convey the ethical assumptions characteristic to managed care. The relationships between physician incentives, patients’ responsibilities in their care, and the physician-patient relationship are examined as ethical concerns recognized in the managed care system. Managed care's organizational controls have changed from a physician-patient relationship to a businessperson-consumer relationship. The managed care systems’ objectives necessitate the physician to be both a patient advocate and an organizational advocate, even though these positions conflict. The paper also reemphasizes the managed care's moral duty is crucial for enabling physicians, patients, payers and policymakers …show more content…
It necessitates the physician to keep their patients’ information confidential, to avoid mischief and sexual misconduct, and to give no harmful or lethal agents. In short, the physician must become their patients’ advocate, using their professional knowledge and the patient's trust for the patient's good. Managed care forces physicians to balance the interests of their individual patients with the interests of other patients in the system by requiring them to ration care and constrain costs, and may place the physician in a position where the needs of their patients are in conflict with his own financial interests. The physician’s income may be at risk also because many managed care organizations drop physicians who incur higher cost treatments than their colleagues, even though they take care of sicker patients. This fear of retribution for providing appropriate, but more expensive care can become a powerful force in distorting physicians' clinical judgment. The "ethics of minimums" as a corporate culture is at variance with the physician's training and basic integrity (Hall,