Trusting Medicine: The Moral Costs of Managed Care

Description

Providing a fascinating overview of healthcare spending and cost-containment mechanisms in the US, this book explores the consequences of managed care for the community with particular attention paid to doctor-patient relationships. The author studies this significant relationship from a social perspective arguing that shifting financial risk onto doctors in a profit-making system seriously damages patient trust. In addition this undermines overall social capital, which in turn has been linked to health outcomes. Including case study examples and policy implications, this insightful text explores an important, though little-discussed outcome of healthcare reform and will be a welcome addition to the current healthcare literature. Cover Half Title Title Copyright Dedication Contents Acknowledgements Introduction An overview of this book Defining managed care 1 Conflicting values in a troubled health-care system The cost of care Ethical assumptions, principles and theories Stewardship, social justice and contributive justice 2 Bluffing, puffing, and spinning Bluffing and the warranty theory of truth Deception within health plans Physician deception Deception through silence: debating disclosure Warranting the truth Patient deception: damned if they do, damned if they don't Assumption of the risk 3 Trust: the scarcest of medical resources Trust The doctor-patient relationship: a vessel of trust Medical trust at risk Coping with the problem of declining trust between doctor and patient Trust as procedural justice Fragility of trust Costs of conserving trust 4 The doctor-patient relationship in a social context Social relations are important for health promotion The impact of income inequality on health Managed care and the erosion of the professional practice standard The myth of choice 5 Conserving medical trust for the sake of social capital Trust and social capital The consequences of diminishing social capital for individuals Harms to the community from our depleted fund of social capital Implications for the consent argument Protecting our reservoir of medical trust Trading trust 6 Law, its meaning, and its effect on social capital Expressive theories of law ERISA: a window of opportunity Pegram v. Herdrich Expressive content and social capital The professional practice standard Thinking about policy implications 7 Employer leadership in the era of workplace rationing Starting with clinical ethics Employers cum proxy decision-makers Implementing substituted judgment Best-interest-of-the-employee test Employer cost shifting and the failure to meet proxy criteria Employer leadership in exercising discretion The argument from social capital 8 Protecting medical trust, conserving social capital Bibliography Index