Ethical issues in managed care

"Within the next ten years almost all insured Americans will obtain medical services through managed care" (Dallek and Geraldine, press release, 1995). The emergence and expected dominance of managed care has transformed every dimension of health care and created new ethical and policy questions. In particular, it has reshaped the physician-patient relationship and threatens the physician's role as a patient advocate. The author's aim in this article is to set out some of the major ethical issues in these two areas. This review only discusses some of the most obvious and pressing ethical problems in managed care.