Managing Care: A Shared Responsibility

<P><STRONG>Part 1. Health care costs and scarcity. </STRONG><STRONG>1.</STRONG> <STRONG>Introduction.</STRONG> <STRONG>2. Development of Managed Care.</STRONG>&nbsp;<STRONG>2.1 </STRONG>The concepts of "costs". <STRONG>2.2 </STRONG>Economic restraints. <STRONG>3. Rationing: A dilemma for ethicists.</STRONG>&nbsp;<STRONG>3.1 </STRONG>Scarcity is an economic reality. <STRONG>3.2 </STRONG>Ethics and rationing.&nbsp;<STRONG>3.3 </STRONG>Medical necessity. <STRONG>3.4 </STRONG>Cost effectiveness and cost benefit analysis. <STRONG>3.5 </STRONG>Affordability. <STRONG>3.5 </STRONG>A comprehensive approach. <STRONG>3.6 </STRONG>Talking about responsibility. <STRONG>4. Responsibility. 4.1 </STRONG>What is the distribution claim made by agency theories? <STRONG>4.2 </STRONG>Normative weakness. <STRONG>4.3 </STRONG>Responsibility: the key notion. <STRONG>4.4 </STRONG>"Genuine responsibility" as a proposal for a unifying paradigm.&nbsp;<STRONG>Part 2.&nbsp;The concept</STRONG><STRONG> of managed care and its practical implications.&nbsp;</STRONG><STRONG>1. Introduction.</STRONG> <STRONG>2. Quality of Care in Managed Care. 2.1 F</STRONG>airness in managed care. <STRONG>2.2 </STRONG>Public distrust. <STRONG>3. History of Managed Care. 3.1</STRONG> Economic Pressure. <STRONG>3.2 </STRONG>Medical Waste as a Contributor to Cost. <STRONG>4.Where does managed care find its market. 5.</STRONG> <STRONG>Definition of managed care.</STRONG> <STRONG>5.1 </STRONG>Different forms of managed care.&nbsp;<STRONG>5.2 </STRONG>Implications of managed care. <STRONG>5.3</STRONG>&nbsp;Characteristics of managed care. <STRONG>5.4 </STRONG>Expectations and disappointments. <STRONG>6. Managed care&nbsp;as unknown territory.</STRONG> <STRONG>6.1</STRONG> Distribution by managing outcomes. <STRONG>6.2 </STRONG>Utilization versus best practice data. <STRONG>6.3 </STRONG>What ought to be versus what is. <STRONG>7. Methodological concerns regarding data collection. 7.1 </STRONG>Normative concerns&nbsp;about data. <STRONG>8. Population-based distribution and individual autonomy. 8.1 </STRONG>Reconsidering medical paternalism. <STRONG>8.2&nbsp;F</STRONG>oundation of a rights-orientated health care. <STRONG>9. Balancing responsibilities. 9.1&nbsp;</STRONG>Denial of liability and accountability. <STRONG>9.2 </STRONG>Responsibility of MCOs to members.<STRONG> 10. Changes in managed care. 10.1</STRONG> The obvious question.&nbsp;<STRONG>Part 3.&nbsp;Ideology: the silent partner. 1.</STRONG> <STRONG>Introduction.</STRONG> <STRONG>2. The concept of ideology. 3. Ideology in medicine. 3.1 </STRONG>Ideological components in the definition of health. <STRONG>3.2 </STRONG>Models of causation of disease and their ideological relevance. <STRONG>4. The context of scarcity and its ideological impact on health care. 4.1 </STRONG>The ideological context of the model of rationing and its symbolicy forms. <STRONG>5. Conclusion.&nbsp;Part 4.&nbsp;Concept of Genuine Responsibility. 1. Introduction. 2. Changing the focus in health care distrisbution. 2.1 </STRONG>Unlimited access versus cost containment. <STRONG>2.2 </STRONG>An analogy. <STRONG>2.3 </STRONG>An ethics approach. <STRONG>2.4</STRONG> Rationality and Empathy.&nbsp;<STRONG>3. The notion of responsibility. 3.1 </STRONG>An ethics of genuine responsibility. <STRONG>3.2 </STRONG>The definition of "Genuine Responsibility". <STRONG>3.3 </STRONG>Implications on the notion of personal responsibility. <STRONG>4. Justice and health care. 4.1 </STRONG>Just health care. <STRONG>4.2 </STRONG>The odds of just health care. <STRONG>4.3 </STRONG>Impediment to justice.&nbsp;<STRONG>5. Key presumptions. 5.1 </STRONG>Challenging the notion of responsibility in managed care. <STRONG>5.2 </STRONG>Health care distribution&nbsp;in a&nbsp;free-market economy. <STRONG>5.3 </STRONG>Justice as appropriation.&nbsp;<STRONG>Part 5: Revising the template for modeling health care. 1. Introduction.</STRONG> <STRONG>2.</STRONG> Necessity for change. <STRONG>2.1 Recapitulating the applied theoretical framework. <STRONG>2.2 </STRONG>The ideological argument in the health care debate. <STRONG>3. Defining health and health care. 4. The main parties involved.</STRONG> <STRONG>4.1 </STRONG>Society. <STRONG>4.1.1 </STRONG>Justice and public policy making. <STRONG>4.1.2 </STRONG>The contribution of justice as appropriation. <STRONG>4.1.3 </STRONG>The contribution of genuine responsibility to the debate. <STRONG>4.1.4 </STRONG>Defining entitlement to healthcare. <STRONG>4.2 </STRONG>Government. <STRONG>4.2.1 </STRONG>Privatization and cost containment. <STRONG>4.2.2 </STRONG>Empirical observations. <STRONG>4.3 </STRONG>Recapitulation. <STRONG>4.3.1 </STRONG>Genuine responsibility and health care business. <STRONG>4.4 </STRONG>Managed care organizations. <STRONG>4.4.1 </STRONG>Business as moral agent. <STRONG>4.4.2 </STRONG>Corporate citizenship in the market place. <STRONG>4.4.3 </STRONG>Corporate responsibility and the healthcare business. <STRONG>4.4.4 </STRONG>Prioritization of interests. <STRONG>4.4.5 </STRONG>The nature and the scope of responsibility. <STRONG>4.4.6 </STRONG>Solidarity and the notion of universal access. <STRONG>4.4.7 </STRONG>The&nbsp;implications for managed care organizations. <STRONG>4.4.8 </STRONG>Two alternatives for control. <STRONG>4.4.9 </STRONG>How genuine responsibility would guide managed care distribution. <STRONG>4.4.10 </STRONG>Compliance or integrity behavior. <STRONG>4.4.11 </STRONG>Accounting for the focus on for-profit managed care organizations. <STRONG>4.4.12 </STRONG>Effects of the Principle of Genuine Responsibility on Managed Care. <STRONG>4.5 </STRONG>What does genuine responsibility expect from health care professionals? <STRONG>4.5.1 </STRONG>Physician as gatekeeper of faithful provider. <STRONG>4.5.2 </STRONG>Best practice and practice guidelines. <STRONG>4.6 </STRONG>Individual members of the moral community.&nbsp;<STRONG>Part 6:&nbsp;Theoretical reflections. 1. Introduction. 2. Managed care.</STRONG>&nbsp;<STRONG>2.1</STRONG> Public frustration. <STRONG>2.2 </STRONG>Healthcare as business. <STRONG>3. The problem: who is responsible for what? 3.1 </STRONG>Defining responsibility. <STRONG>3.2 </STRONG>Genuine responsibility. <STRONG>4. Justice as Appropriation</STRONG>. <STRONG>4.1 </STRONG>Ideology and discourse ethics. <STRONG>5.&nbsp;A template for responsible healthcare distribution. 5.1 </STRONG>Realism or idealism?&nbsp;<STRONG>Part 7:</STRONG> <STRONG>Implementation in U.S. Health Care System: Challenges and Opportunities. 1. Introduction. 2. Changing the views on business and profits. 3.</STRONG> <STRONG>Individual entitlement and social justice. 3.1 </STRONG>What is just? <STRONG>3.2 </STRONG>Moral authority. <STRONG>3.2.1 </STRONG>Necessary conditions anchoring moral authority. <STRONG>4. The role of government. 4.1 </STRONG>Covering the basics. <STRONG>4.2 </STRONG>Government involvement. <STRONG>4.3 </STRONG>The domain of government’s responsibility. <STRONG>4.4 </STRONG>Obstacles to a Subsidy Model. <STRONG>5. Health care planning. 5.1</STRONG> Government mandated health planning. <STRONG>5.2</STRONG>&nbsp;The argument for government involvement. <STRONG>5.3 </STRONG>From theory to practice. <STRONG>5.4 </STRONG>Discussing the options. <STRONG>5.5 </STRONG>Determining priorities.<STRONG>6. Health care budgeting.</STRONG> <STRONG>6.1 </STRONG>Implementing budget-based delivery systems. <STRONG>6.2 </STRONG>Decentralized healthcare. <STRONG>7. Special interest groups and policy making. 7.1 </STRONG>Reviewing&nbsp;options. <STRONG>7.2 </STRONG>Substantive access rules. <STRONG>7.3 </STRONG>Practical challenges. <STRONG>8.&nbsp;The minimum health care benefit package. 9. The contribution of evidence based medicine. 9.1&nbsp;</STRONG>Practice guidelines. <STRONG>9.2 </STRONG>Theory and practice; Coming full circle. <STRONG>9.3 </STRONG>Closing the loop.&nbsp;<STRONG>Bibliography.&nbsp;Index. </STRONG></P>