Discussions of managed care frequently begin and end with an opposition between the Hippocratic ethic of dedication to patient welfare and a business ethic of self-interest in the service of efficiency. Mary R. Anderlik approaches managed care as a problem of organizations. Rejecting a simple "medicine vs. business" analysis, she directs attention to management as manipulation, the neglect of such personal goods as satisfaction in professional accomplishment, and organizational moral myopia.
In this account, "pragmatic" suggests practical idealism, not the jettisoning of principle in the interests of expediency. In The Ethics of Managed Care, Anderlik favors a broad empiricism and a moral vision centered on values of democracy and community. She describes how organizations can nourish or destroy openness, creativity, cooperation, and faithfulness—and display "virtues" such as justice, integrity, responsiveness, and efficiency, rightly understood. She uses community care clinics, asthma outreach programs, and new contexts for participatory decision-making to show the promise of managed care. She also explains the complexities of financial arrangements, arguing for an end to schemes that reward clinicians for providing less care and profiting from avoiding people who need a lot of it. The book concludes with a look at the future of managed care, proposing a program for reform.
Preliminary Table of Contents:
1. Managed Care as Social Experiment and Social Problem
2. Managed Care and the Medicine-Business Polemic
3. An Ethic for an Age of Organizations
4. Kaiser Permanente: An Organizational Character Study
5. The Market, Professionalism, and Cooperative Egalitarianism in Health Care
6. Making Sense of Managed Care
Conclusion: The Future of Managed Care
The book is well footnoted and well reasoned . . .~Choice
Anderlik (Univ. of Houston Law Center) argues that managed care has by default become society's medical care rationing agent. She decries this role and points to Kaiser Permanente as a managed care organization that has both social conscience and genuine concern for its enrollees. Anderlik posits that organizations can and should nourish human personalities and display virtues such as justice, integrity, responsiveness, and efficiency. The pervasiveness of financial incentives to save health care money is, the author believes, at the center of the problem. This work is an exploration of the care giving in today's managed care setting, from the perspective of an ethical position that managed care organizations are not meeting ethical obligations to their enrollees. The book is well footnoted and well reasoned, but readers will have to accept the ethical assertions made by the author. All levels.~J. E. Allen