Ethical Issues in Managed Care

Abstract

Cooper and Gottlieb (2000 [this issue]) have provided an intensive and extensive analysis of ethical issues that can arise in conjunction with various policies promulgated by managed care organizations. They highlight dilemmas for practitioners and suggest methods of resolution that are immediately applicable. They also offer a number of recommendations for curriculum development and propose an ambitious research agenda to increase our knowledge of relevant issues. Yet, this is more than an article about ethical issues. It also provides a summary of changes in the health care delivery system, addresses implications for education and research in psychology, and promotes a forward-thinking perspective regarding education, research, and practice in the evolving health care system. I found their work to be thoughtful and, on the whole, balanced. It would significantly enhance the curriculum of any professional psychology education and training program. However, I do not agree with their opinion that "we do not expect managed care to survive over the long term" (p. 230), which is perhaps due to the definition that they adopt as the basis for their analysis.In their discussions, Cooper and Gottlieb (2000) tend to rely on mainstream psychology's definition and perceptions of managed care. For example, they cite Corcoran and Vandiver (1996) for the definition that "managed care refers to the administration of physical and mental health care services by a party other than the practitioner or client" (p. 183). This definition tends to focus on a particular methodology in managed care, and thus highlights problems related to confidentiality and utilization review procedures. However, this definition is more narrow than that found in the broader health care literature, and thus might lead us to (a) overgeneralize about managed care (despite the authors' acknowledgment of the diversity of models involved), (b) ignore the ethical dilemmas for psychology within a broader definition, and (c) underestimate the ethical problems associated with unmanaged care.Goldstein (1992) provides a definition of managed care that avoids describing a particular strategy of management, but instead focuses on the crucial elements of managed health care.

Ethical decision making in mental health contexts: Representative models and an organizational framework.

“…A number of publications address specifi c challenges when serving clients who have faced such issues as (a) domestic violence or battered women (e.g., Edwards, Merrill, Desai, & McNamara, 2008 ;Koenig, Rinfrette, & Lutz, 2006 ), (b) end-of-life care (e.g., Werth, 2002 ), (c) geriatric neuropsychology (e.g., Martin & Bush, 2008 ), and (d) HIV and AIDS. There also have been models or guidelines developed for serving clients within specifi c contexts, such as (a) religious communities (e.g., Hill & Mamalakis, 2001 ), (b) managed care (e.g., Belar, 2000 ;Tjelveit, 2000 ;Younggren, 2000 ), (c) child clinical psychology (e.g., Mannheim et al, 2002 ), (d) outpatient care ( Truscott, Evans, & Mansell, 1995 ), and (e) play therapy ( Seymour & Rubin, 2006 ). And there are recommendations for psychologists who counsel specifi c populations of clients, such as Asian Americans (e.g., Littleford, 2007 ) or those vulnerable to exploitive dual relationships ( Gottlieb, 1993 ).…”