Managing Managed Care

Managed healthcare is not new. It has been around at least since 1869, when the Sisters of Charity of the Incarnate Word offered a prepaid plan for comprehensive healthcare at St. Mary’s Infirmary in Galveston.

The controversies surrounding managed care are not new, either, and they are likely to continue. As baby boomers age and medical costs spiral, few legislative issues will attract as much attention—or produce as much vitriol—as managed care.

Although most people see the debate surrounding managed care as a simple dichotomy of medicine versus business, Mary R. Anderlik ’97 argues that defenders of both viewpoints focus too narrowly on that aspect and miss the larger social and moral contexts. “Stories of personal tragedy and corporate greed largely define managed care in the popular press,” she writes in The Ethics of Managed Care (Indiana University Press, 2001). “Yet this story is too complex, too full of moral ambiguity to fit neatly within the confines of any simple framework.”

Anderlik approaches managed care as a problem of organizations—in particular the character of organizations and the kinds of character traits they form in the persons they affect, the relationship between business and bureaucracy, and the scale and complexity of organizational and bureaucratic structures. She also considers that the professional ideals of medicine, “with its great promise and its susceptibility to abuse,” have a major impact on the quality of managed care.

After delving into those issues, she examines the practices of managed care, including financial incentives, the exchanges of disclosure and consent that may lend legitimacy to rationing, and other limits imposed by health plans. Her next consideration is the potential of ethicists, ethics committees, and various other forms of external oversight to move managed care in desirable directions and discourage abuses. She finishes with a look at the future, arguing that “managed care as we know it is a transitional phenomenon, an ongoing experiment in remolding values and organizations.” In conclusion, she offers a set of seven guidelines for decision makers involved in shaping healthcare’s future.

Anderlik earned her Ph.D. at Rice and has a J.D. from Yale Law School. She held a postdoctoral fellowship in clinical ethics at the University of Texas M.D. Anderson Cancer Center and served as a research professor at the Health Law and Policy Institute at the University of Houston Law Center. Currently, she is at the University of Louisville, where she is an associate professor in the School of Medicine and a research scholar for the Institute for Bioethics, Health Policy, and Law.

—Christopher Dow