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Balancing Act
The New Medical Ethics of Medicine's New Economics
E. Haavi Morreim
Georgetown University Press, 1995

Medicine's changing economics have already fundamentally, permanently altered the relationship between physician and patient, E. Haavi Morreim argues. Physicians must weigh a patient's interests against the legitimate, competing claims of other patients, of payers, of society as a whole, and sometimes even of the physician himself.

Focusing on actual situations in the clinical setting, Morreim explores the complex moral problems that current economic realities pose for the practicing physician. She redefines the moral obligations of both physicians and patients, traces the specific effects of these redefined obligations on clinical practice, and explores the implications for patients as individuals and for national health policy. Although the book focuses on health care in the United States, physicians everywhere are likely to face many of the same basic issues of clinical ethics, because every system of health care financing and distribution today is constrained by finite resources.

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The Challenge of Regulating Managed Care
John E. Billi and Gail B. Agrawal, Editors
University of Michigan Press, 2001
Representatives of industry, government, caregivers, and consumers join scholars and policy analysts in comparing market forces to regulation as potential means for righting what is wrong with managed care. The contributors that John E. Billi and Gail B. Agrawal have gathered here quickly move the healthcare debate beyond the classroom, think tank, and statehouse to the boardroom and examining room.
Some argue strongly that the solution is to be found in the democratic process and government intervention, while others maintain that only market forces in a competitive environment can respond quickly to the needs of consumers and purchasers alike. The contributors' diverse opinions about the oversight of managed care reflect an enduring divide, one that will affect how society ultimately resolves questions about the inevitable tradeoffs among health-care quality, cost, and access in an environment of limited resources.
The Challenge of Regulating Managed Care will appeal to policymakers, those in the medical field, and all readers interested in the American experience with managed care.
John E. Billi is Associate Professor of Internal Medicine and Medical Education; Associate Dean for Clinical Affairs, University of Michigan Medical School; and Associate Vice President for Medical Affairs, University of Michigan.
Gail B. Agrawal is Associate Professor of Law, University of North Carolina, Chapel Hill.
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Ethical Challenges in Managed Care
A Casebook
Karen G. Gervais, Reinhard Priester, Dorothy E. Vawter, Kimberly K. Otte, and Mary M. Solberg, Editors
Georgetown University Press, 1999

The rapid rise of managed care in the United States has introduced new complexities into ethical dilemmas in health care by changing the traditional relationships among health plans, payers, providers, and patients. Through twenty case studies that provide snapshots of a wide range of ethical challenges, this book explores the goals, methods, and practices of managed care.

Accompanying each case are questions for consideration and a pair of commentaries by prominent contributors from diverse fields. Through the cases and commentaries, this book clarifies the internal workings of managed care, explains relevant concepts, and offers practical, constructive guidance in addressing the ethical and policy issues.

The cases address a broad spectrum of issues concerning rationing shared resources, financial incentives, quality of care, and responsibilities to patients, vulnerable populations, and the community. Specific topics range from coverage of emergency services through funding medical education to respecting patients' religious beliefs and caring for the seriously mentally ill.

This casebook offers a wealth of insights into critical issues that affect the delivery of managed care in an increasingly competitive market. It will be invaluable for those managing the delivery and financing of health care and for students and practitioners of the health professions and health administration, as well as interested recipients of managed care.

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Ethical Considerations in the Business Aspects of Health Care
Woodstock Theological Center
Georgetown University Press, 1995

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Ethical Issues in Managed Health Care Organizations
Woodstock Theological Center
Georgetown University Press, 1999

A review of the complex ethical problems that confront many professionals and decision makers in managed care systems.

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Healthy Markets?
The New Competition in Medical Care
Mark A. Peterson, ed.
Duke University Press, 1999
When federal and state policy makers’ efforts to enact sweeping health care reform in the mid-1990s ended in stalemate, the private sector unleashed initiatives that have affected virtually every aspect of health care. With updated essays first published in issues of the Journal of Health Politics, Policy and Law, Healthy Markets? offers the most comprehensive and critical examination yet found in a single volume of the economic, political, and social implications of this recent market transformation of health care in the United States.
With original contributions from leading social science health policy analysts, this volume addresses the full context of health system change. Believing that the analysis of health care change is too important to be left to economists alone, Mark A. Peterson has collected a mulitdisciplinary group of experts who revisit the contentious debate over the market approaches to health care and consider the disparate effects of these approaches on cost, quality, and coverage of both managed care and Medicaid and Medicare. While market enthusiasts applaud the enhanced efficiency, reduced excess capacity, and abatement of the decades-long health care cost explosion, a backlash has emerged among many providers and the public against the perceived excesses of the market: diminished access to care, commercialization of the physician-patient relationship, and exacerbated inequality. Contributors assess these varied responses while examining the impact that market-based applications are likely to have for future health policy making, the significance of the U.S. experience for policy makers abroad, and the lessons that these changes might provide for thinking sensibly about the future of our health care system.
This volume will be useful for public policy analysts, economists, social scientists, health care providers and administrators, and others interested in the future—and in understanding the past—of American health care.

Contributors. Gary S. Belkin, Lawrence D. Brown, Robert G. Evans, Martin Gaynor, Paul B. Ginsburg, Marsha Gold, Theodore R. Marmor, Cathie Jo Martin, Jonathan B. Oberlander, Mark V. Pauly, Mark A. Peterson, Thomas Rice, Deborah A. Stone, William B. Vogt, Kenneth E. Thorpe

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Managed Care and Monopoly Power
The Antitrust Challenge
Deborah Haas-Wilson
Harvard University Press, 2003

As millions of Americans are aware, health care costs continue to increase rapidly. Much of this increase is due to the development of new life-sustaining drugs and procedures, but part of it is due to the increased monopoly power of physicians, insurance companies, and hospitals, as the health care sector undergoes reorganization and consolidation. There are two tools to limit the growth of monopoly power: government regulation and antitrust policy. In this timely book, Deborah Haas-Wilson argues that enforcement of the antitrust laws is the tool of choice in most cases.

The antitrust laws, when wisely enforced, permit markets to work competitively and therefore efficiently. Competitive markets foster low prices and high quality. Applying antitrust tools wisely, however, is a tricky business, and Haas-Wilson carefully explains how it can be done. Focusing on the economic concepts necessary to the enforcement of the antitrust laws in health care markets, Haas-Wilson provides a useful roadmap for guiding the future of these markets.

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The Managed Care Blues and How to Cure Them
Walter A. Zelman and Robert A. Berenson
Georgetown University Press, 1998

Shattering the myths about what’s wrong with managed health care, this penetrating introduction to managed care explains its origins and identifies its real achievements and shortcomings.

Walter A. Zelman and Robert A. Berenson argue that many criticisms of managed care tend to idealize the costly and fragmented insurance system it supplanted, without pinpointing the true inadequacies of today’s managed care. In addition to providing reasoned answers to the most alarmist critiques of managed care, the authors maintain that it has not fulfilled its potential to improve the overall quality of care.

The authors propose thirteen concrete recommendations for raising quality in managed care programs, ranging from enacting additional legal protections and increased disclosure to putting the purchasing power in the hands of those who care most about quality — individuals, rather than employers.

With practical solutions for making managed care better, The Managed Care Blues and How to Cure Them is a bold call for greater consumer protection, knowledge, and power in the health care arena.

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Under the Mask
A Guide to Feeling Secure and Comfortable During Anesthesia and Surgery
Cottrell, James M.D.
Rutgers University Press, 2001

Every year, about forty million Americans require surgery. Few truly understand what happens to them during the procedure-especially what the anesthesiologist does to ensure their survival and well being. An anesthesiologist disarms your entire nervous system with the most effective drugs for your body chemistry; keeps you alive while you're subjected to manipulations that would otherwise kill you; and ensures your safe return to consciousness. Yet despite their crucial role, anesthesiologists are often the unseen doctors. Under the Mask, written by a compassionate practitioner, demystifies the surgical process with detailed information that will make you a better-informed consumer.

Part One describes the development and current scope of anesthesiology, the medications and techniques used, and what the anesthesiologist does both in and outside the operating room. It explains your-the patient's- rights and advises you how to use the preoperative consultation with the anesthesiologist to your best advantage, specifying what information you need provide and what questions you should ask.

Part Two details the most common surgical and diagnostic procedures requiring anesthesia or conscious sedation. Using clear language, it explains each procedure, the possible risks, and the choices to make if there is more than one option. It also covers the anesthesiologist's crucial role in controlling pain caused by chronic conditions. The last chapter describes the newest anesthetic and pain control techniques available.

The author also helps you understand anesthesiology within the managed care system and explains what you can expect and what to do if you aren't getting what you need. This book enables you to make informed decisions regarding surgical anesthesia and subsequent pain control within the managed care system to protect your well-being and hasten your recovery.
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