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Managed Care: Title and subTitle BreakJekyll or Hyde? FREE

Carolyn M. Clancy, MD; Howard Brody, MD, PhD
[+] Author Affiliations

The opinions expressed are the authors and do not represent the position of the Agency for Health Care Policy and Research, the US Public Health Service, or the Department of Health and Human Services.

Corresponding author: Carolyn M. Clancy, Division of Primary Care, Agency for Health Care Policy and Research, EOC 502, 2101 E Jefferson St, Rockville, MD 20852.


JAMA. 1995;273(4):338-339. doi:10.1001/jama.1995.03520280084046
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The topic most discussed by physicians today is the increasing percentage of US health care being taken over by managed care organizations.1 While physicians in practice are struggling to interpret the requirements and implications of contracts with emerging or established health care systems,2 many academic medical centers have also joined the "dance of vertical integration."3,4 What has not emerged from the ofttimes emotional discussions is a cogent examination of the impact of the transformation of medical practice from a cottage industry to a corporate enterprise on how we deliver care, assess and improve the quality of care, and educate future physicians. It is an urgent matter, then, for the medical profession to address the ethical principles that will preserve a sound physician-patient relationship within this rapidly changing environment.

See also pp 323 and 330.

To address the ethics of the physician-patient relationship in managed care realistically and

REFERENCES

Iglehart JK.  The struggle between managed care and fee-for-service practice. N Engl J Med . 1994;;331:63-67.
Williams BJ.  The train is leaving the station. N Engl J Med . 1994;;331:1316-1317.
Kassirer JP.  Academic medical centers under siege. N Engl J Med . 1994;;331: 1370-1371.
Iglehart JK.  Rapid changes for academic medical centers. N Engl J Med . 1994;; 331:1391-1395.
Friedman E.  Doctors and rationing: the end of the honor system. Prim Care . 1986;;13:349-364.
Emanuel EJ, Mezey M, Dubler NN.  Preserving the physician-patient relationship in the era of managed care. JAMA . 1995;;273:323-329.
Franks P, Clancy C, Nutting P.  Gatekeeping revisited: protecting patients from overtreatment. N Engl J Med . 1992;;327:424-429.
Yelin EH, Shearn MA, Epstein WV.  Health outcomes for a chronic disease in prepaid group practice and fee for service settings: the case of rheumatoid arthritis. Med Care . 1986;;24:236-247.
Roulides ZC, Schulman KA.  Physician communication in managed care organizations: opinions of primary care physicians. J Fam Pract . 1994;;39:446-451.
Council on Ethical and Judicial Affairs, American Medical Association.  Ethical issues in managed care. JAMA . 1995;;273:330-335.
Eddy DM.  Rationing resources while improving quality: how to get more for less. JAMA . 1994;;272:817-824.
Cassel CK.  Doctors and allocation decisions: a new role in the new Medicare. J Health Polit Policy Law . 1985;;10:549-564.
Welch HG.  Should the health care forest be selectively thinned by physicians or clear cut by payers? Ann Intern Med . 1991;;115:223-226.
 HMO physician payment: notes from the underground. Physicians Natl Health Program Newslett . (October) 1994;:3.
Passaro V.  Better try not to get sick. New York Times . (October 11) , 1993;:A11.
Berwick DB. Making clinical practice guidelines useful. Presented at the Agency for Health Care Policy and Research Conference; November 8,1994; Rockville, Md.

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Iglehart JK.  The struggle between managed care and fee-for-service practice. N Engl J Med . 1994;;331:63-67.
Williams BJ.  The train is leaving the station. N Engl J Med . 1994;;331:1316-1317.
Kassirer JP.  Academic medical centers under siege. N Engl J Med . 1994;;331: 1370-1371.
Iglehart JK.  Rapid changes for academic medical centers. N Engl J Med . 1994;; 331:1391-1395.
Friedman E.  Doctors and rationing: the end of the honor system. Prim Care . 1986;;13:349-364.
Emanuel EJ, Mezey M, Dubler NN.  Preserving the physician-patient relationship in the era of managed care. JAMA . 1995;;273:323-329.
Franks P, Clancy C, Nutting P.  Gatekeeping revisited: protecting patients from overtreatment. N Engl J Med . 1992;;327:424-429.
Yelin EH, Shearn MA, Epstein WV.  Health outcomes for a chronic disease in prepaid group practice and fee for service settings: the case of rheumatoid arthritis. Med Care . 1986;;24:236-247.
Roulides ZC, Schulman KA.  Physician communication in managed care organizations: opinions of primary care physicians. J Fam Pract . 1994;;39:446-451.
Council on Ethical and Judicial Affairs, American Medical Association.  Ethical issues in managed care. JAMA . 1995;;273:330-335.
Eddy DM.  Rationing resources while improving quality: how to get more for less. JAMA . 1994;;272:817-824.
Cassel CK.  Doctors and allocation decisions: a new role in the new Medicare. J Health Polit Policy Law . 1985;;10:549-564.
Welch HG.  Should the health care forest be selectively thinned by physicians or clear cut by payers? Ann Intern Med . 1991;;115:223-226.
 HMO physician payment: notes from the underground. Physicians Natl Health Program Newslett . (October) 1994;:3.
Passaro V.  Better try not to get sick. New York Times . (October 11) , 1993;:A11.
Berwick DB. Making clinical practice guidelines useful. Presented at the Agency for Health Care Policy and Research Conference; November 8,1994; Rockville, Md.
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