THE IMPACT OF THE CURRENT EMPHASIS ON MANAGED CARE ON THE DELIVERY OF HEALTH CARE
Changing social structures are leading to evolving approaches to the delivery of health care. The roles of the various professional providers of health care also are in a state of transition. Societal changes also are occurring that impact the ethical bases of the functioning of health care delivery systems. Managed care is an evolving approach to the delivery of health care that affects each of these other factors (MacStravic, 1996, pp. 20-23).
Fiscal constraints have caused the United States Congress to initiate actions designed to change the Medicare and Medicaid programs as a way to save money in the form of federal government expenditures (Ellentuck, 1994, p. 78). A leading reform measure for the American health care system generally envisions the widespread implementation of the managed care concept (Kane, 1995, pp. 1690-1691). While managed care is hailed by proponents as a means of conserving health care dollars, many advocates for the elderly and the poor fear that the quality of health care provided to these population groups, and in turn, the quality of life of the majority of the members of these population groups may deteriorate substantially under a managed care regime (Aronson, 1995, pp. 213-231).
Reform of the health care system in the United States is a volatile issue. Costs are the primary concern of funding providers, while a continuation of the opportunity to earn profits is the primary concern of the health insurance industry, and increased access to health care services is the primary concern of social activists. Managed care has been proposed as the concept that can satisfy each of these three groups. Hahn and Flood (1995, pp. 41-59), however, surmised that before any decisions are reached in relation to health care reform, two of the basic assumptions underlying the debate should be validated.
The first assumpti...