Considerations for ethical practice in managed care.

Abstract

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making.

Psychotherapy termination: clinical and ethical responsibilities

“…We also recommend that psychotherapists always appeal, or when legally mandated have their clients appeal, all adverse utilization review decisions (see Wickline v. State of California, 1986). To simply discontinue a patient's treatment in response to an adverse utilization review decision would likely constitute abandonment and not be in keeping with the psychologist's ethical obligations (Acuff et al, 1999).…”

Informed consent to undergo treatment for substance abuse: a recommended approach

“…Some have argued for full disclosure of treatment options and full patient consent (Klerman, 1990) whereas others have seen problems with this approach (Bearhs & Gutheil, 2001;Stone, 1990). Increasing liability for failure to provide full disclosure of risks of treatment may contribute to the interest in informed consent (Acuff et al, 1999;Bearhs & Gutheil, 2001). However, there is very limited literature on the applications of informed consent in substance abuse treatment, including the issue of competence (Roberts, 2002b).…”

“…In contemporary treatment ethics, obtaining informed consent from research subjects as well as patients and clients has become a routine expectation as a way to promote self-determination and autonomy (Acuff et al, 1999;Sugarman et al, 1999). The informed consent process in research has application to clinical practice because of experience with consent in clinical trials in various treatment settings.…”

Developing a comprehensive safety performance evaluation framework for Saudi schools

“…This research stage was considered very important since it provided expert confirmation on the identified factors and items and also explored whether other factors or items are potentially needed. Expert review was selected as the first research stage for this study because it provided the researcher with an opportunity to explore the complex attitudes, beliefs, feelings, motivations, experiences, reactions, and behaviours of Saudi school users (Christensen, 2010) in a way that is not viable with other methods such as observation or surveys (Acuff et al, 1999;Morton, 1982). In addition, expert review provided a friendly atmosphere that stimulated participants to openly discuss their ideas and to actively interact with the researcher (Acuff et al, 1999;Morton, 1982).…”