Ethical issues of managed care

As managed care arrangements flourish, the effects of high health care costs will be increasingly shared among third-party payers, providers, and patients. The dominance of cost-consciousness and managed care mania in the medical marketplace challenges the autonomy of both physicians and patients. Profit motives, demand management, limitations on reimbursement, and restrictions on the amount and type of emergency care patients may receive constrain the moral mission of would-be healers in the medical-industrial complex. Health care is admittedly an important business and the responsible allocation of scarce resources are important societal concerns. However, for physicians working in the shadow of the managed care machine, blind allegiance to the bottom line jeopardizes professionalism and patients' trust. For emergency physicians, the bottom line must remain patient welfare and safety.