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Managed Care: Ethical Issues FREE

John La Puma, MD
JAMA. 1995;274(8):610-610. doi:10.1001/jama.1995.03530080025027
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To the Editor.  —The recent exploration of the ideal physician-patient relationship is puzzling.1 Physicians and patients are already in actual relationships, and practical help is needed to turn those relationships into partnerships within managed care.The modern physician-patient relationship without managed care now focuses on the individual patient, not a patient population. It recognizes patient autonomy as the key ethical principle, not proportionality. It values trust (and competence and compassion) more than accountability. It appreciates the subjectivity of patients' signs and symptoms and finds them difficult to quantify. It embodies a clinical approach to patient care, not an administrative one.2The most important anticipated change in the physician-patient relationship, however, is that more patients are likely to have one, even if the relationship under managed care is different and not ideal.3 Managed care plans are more affordable than fee-for-service plans, and many people who enroll will have

REFERENCES

Emanuel EJ, Dubler NN.  Preserving the physician-patient relationship in the era of managed cafe. JAMA . 1995;;273:323-329.
La Puma J.  Anticipated changes in the doctor-patient relationship in the managed care and managed competition of the Health Security Act of 1993. Arch Fam Med . 1994;;3:665-671.
La Puma J, Schiedermayer DL.  The ethics of managed care and managed competition: problems and promises.  In: Nash D, ed. A Physician's Guide to Managed Care . Rockville, Md: Aspen; 1994;:31-60.

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Emanuel EJ, Dubler NN.  Preserving the physician-patient relationship in the era of managed cafe. JAMA . 1995;;273:323-329.
La Puma J.  Anticipated changes in the doctor-patient relationship in the managed care and managed competition of the Health Security Act of 1993. Arch Fam Med . 1994;;3:665-671.
La Puma J, Schiedermayer DL.  The ethics of managed care and managed competition: problems and promises.  In: Nash D, ed. A Physician's Guide to Managed Care . Rockville, Md: Aspen; 1994;:31-60.
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