Erica L. Montgomery
Module 4 SLP Managed Care
MHM/522 Legal Aspects of Health Administration
Dr. Paulchris Okpala
June 1, 2015
The paper, “Physician Incentives: Managed Care and Ethics”, depicts the ethical practice in medicine, and in extension in the MCOs, as well as the economic part of these enterprises. The authors are attempting to emphasize the thin line which exists between morality and business pursuit in the course of execution of duty by MCOs. These two objectives are likely to conflict during the course of caring for patients thus putting into question the ideals and principles which should be dominant in such situations. The authors look on the power of doctor-patient relationship over the ever stronger business-consumer relationship. The paper manages to depict two, often contrasting, and sides of medical practice which cannot be avoided in MCOs.
Medicine has traditionally held the proud reputation of being a moral institution. Managed care organizations (MCOs) are by extension part of this long-standing medical culture and it will always strive to uphold these morals. Despite such nobility in the greater medical field, MCOs are business entities with economic incentives (Gomez and Hall, 2005). Profitability, cost efficiency, and revenue maximization remain very much at the core of these business entities. The MCOs are, therefore, constantly faced with the daunting task of balancing the moral and economic objectives of their enterprises. The statement presented in the paper’s conclusion is aimed at reminding the reader that MCOs have strong financial incentives which ought not to be overlooked when discussing the morality of the practice.
The physician’s dual function under the MCO model of care refers to the duties these institutions have to their patients and their financial and greater social responsibilities (Mains, Coustasse, & Lykens, 2003). The first function stands with best medical practice where the MCO ought to be the patient’s unrestricted advocate. To this end, the MCO is expected to operate within the prism of physician-patient relationship. This implies that the physician needs to observe autonomy and act to benefit the patient. The other side of the dual function involves financial advocacy where MCOs strive to employ means of improving their financial bottom-line. According to Mains, Coustasse, & Lykens (2003), cost cutting measures, resource allocation, and compensation restructuring are some of the ways in which MCOs look to advance their financial advocacy. There is a false security among many that the physicians’ training which emphasizes patient advocacy will always takes precedence. According to Aumer (2003), the practice has not done enough to be held in such moral standards thus the need for constant monitoring.
The most concerning thing about physician-patient relationship is the possibility of financial incentives overlapping patient advocacy. The complete substitution