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Ethical Challenges in Managed Care : A Casebook - Karen Grandstand Gervais

Ethical Challenges in Managed Care

A Casebook

Paperback Published: 1st December 1998
ISBN: 9780878407194
Number Of Pages: 372
For Ages: 22+ years old

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The rapid rise of managed care in the United States has introduced new complexities into ethical dilemmas in health care by changing the traditional relationships among health plans, payers, providers, and patients. Through twenty case studies that provide snapshots of a wide range of ethical challenges, this book explores the goals, methods, and practices of managed care.

Accompanying each case are questions for consideration and a pair of commentaries by prominent contributors from diverse fields. Through the cases and commentaries, this book clarifies the internal workings of managed care, explains relevant concepts, and offers practical, constructive guidance in addressing the ethical and policy issues.

The cases address a broad spectrum of issues concerning rationing shared resources, financial incentives, quality of care, and responsibilities to patients, vulnerable populations, and the community. Specific topics range from coverage of emergency services through funding medical education to respecting patients' religious beliefs and caring for the seriously mentally ill.

This casebook offers a wealth of insights into critical issues that affect the delivery of managed care in an increasingly competitive market. It will be invaluable for those managing the delivery and financing of health care and for students and practitioners of the health professions and health administration, as well as interested recipients of managed care.

Industry Reviews

A timely and welcome attempt to identify important, if not uncommon, predicaments in managed care. Bioethics Forum

Acknowledgmentsp. ix
Introduction Ethical Challenges in Managed Carep. 1
Balancing a Plan's Obligations to Individual Patients and Its Enrolled Populationp. 17
Coverage of Emergency Servicesp. 33
Coverage of Investigational Interventions for Life-Threatening Conditionsp. 49
Coverage of Complementary Health Carep. 66
Coverage Exceptions for Contractually Excluded Benefitsp. 83
Referral Practices Under Capitationp. 101
Shifting Costs and Care to Public Programsp. 118
Choice of Venue and Provider Under Capitationp. 134
Credentialing Standards and Quality Carep. 151
Ceo Salaries in For-Profit and Nonprofit Health Plansp. 168
Hospital Staffing Levelsp. 181
Purchaser and Plan Responsibility for Benefit Designp. 201
Advocating for Patients in Managed Carep. 217
Similarly-Situated Patients with Different Benefits Packagesp. 233
Respecting Patients' Cultural and Religious Beliefsp. 249
Managing Care for the Seriously Mentally IIIp. 267
Quality Care for Elderly Nursing Home Patientsp. 285
Managing Care for Seriously and Chronically III Childrenp. 303
Health Plan Responsibilities for Public Health Activitiesp. 323
Health Plan Responsibilities for Medical Education and Researchp. 340
Contributorsp. 357
Indexp. 367
Table of Contents provided by Publisher. All Rights Reserved.

ISBN: 9780878407194
ISBN-10: 0878407197
Series: Ethical Challenges in Managed Care
Audience: Professional
For Ages: 22+ years old
Format: Paperback
Language: English
Number Of Pages: 372
Published: 1st December 1998
Country of Publication: US
Dimensions (cm): 22.91 x 15.42  x 2.41
Weight (kg): 0.56