Ethical Issues in Managed Care

Managed care in a nutshell sounds like an excellent idea. Paying Doctors for the managed health of the insurers. That means that instead of paying the doctor every time the patient uses their service, they get payed a fixed rate and are encouraged to keep their clients healthy. 

We know that the path to fix our health care system begins with prevention; and managed care focus on that, but it has it's shortcomings. Managed Care relies on gatekeepers and protocols that might limit the selection of physicians your insurance covers; and the latest issue is the limitations imposed on experimental treatment. 

In case study I read a physician "Dr. Stanley" the medical director at Springdale Health Systems, a regional managed care organization was in charge of authorizing or denying the coverage for an 8 year old with terminal cancer. His parents found out of an experimental procedure that could possibly treat their sons cancer. 

Should a physician be responsible for the decisions in the continuing health of a patient? The Hippocratic oath states that a physician should "leave this operation to be performed by practitioners, specialist in this art". Should we interpret this as "a physician should always look for the physician who will treat".

Health Care Management argues that experimental procedures are expensive and most of the time are not successful. But what happens if out of fifty procedures one is successful? 

Where is the beneficence on this case? Where is the greater good? Is the greater good in long term savings of resources and health care money by denying a procedure that has a very slim possibility of being successful; or is the greater good to save the life of one individual even though  resources will be scarce and treatment might not be successful.