Case+9+Literature+Review

Literature Review media type="youtube" key="GgcXdtX2C68" width="378" height="283" Managed care is the term we use to describe the process of providing cost-efficient medical services. Every health insurance company that exists today uses managed care techniques in a variety of ways, and some to a greater extent than others. A frequent issue that exists between providers and an insurance company (also referred to as an MCO) is the extent and/or the type of treatment that will be paid for. While this is not a new problem, it is one that continually expands into new territory. In recent years, the impact of MCO’s on ethical dilemmas has been examined fairly extensively. Almost 20 years ago, Doherty and Heinrich (1996) concluded that “the most pressing ethical concern reflected in the literature is conflict of interest between the clinician and the patient because the clinician is serving two masters: the patient and the managed care organization.”

In particular, providers of mental health services such as psychologists, psychiatrists, professional counselors, and marriage and family therapists have struggled to balance the ethical constraints of their practice with the rapidly changing insurance environment. (Glosoff, Garcia, Herlihy, & Remley 1999) In a study focusing on psychologists, Cooper & Gottlieb (2000) offer a detailed assessment of ways in which “the managed care environment creates ethical dilemmas not heretofore encountered and requires practitioners to address issues that in the past were not necessary.”

One of the primary cornerstones of mental health counseling is the commitment to confidentiality. The ethical requirements and exceptions to confidentiality are extensively addressed in every code of ethics that pertains to the mental health field, including those setting the standard for professional counselors, psychologists, psychiatrists, social workers, and marriage and family therapists. Moffic (2004) notes that the effects of managed care on the principle of confidentiality have been a major concern for behavioral health clinicians, especially since mental health services have been a particular target for cost containment procedures since the late 1980’s. Several articles note the impossibility of guaranteeing client confidentiality once information has been shared with the MCO, both because of the lack of standards governing the employees of the MCO as well as the technology used to share the information. (Cooper & Gottlieb 2000, Moffic 2004, Danzinger & Welfel 2001, Daniels 2001, Younggren 2000) However, Belar (2000) notes that most mental health professionals often work with other professionals as part of a team designed to deliver the maximum level of care. In these cases, the limits of confidentiality extend to sharing information with other professionals, and by extension with their office staff, through a variety of technological tools. Several studies propose that an MCO should be viewed as a valid part of a treatment team, and therefore sharing confidential information with an MCO representative is not really any different than it with any other professional on the team. (Belar 2000, Moffic 2004)

Clinicians such as Martin in our case study struggle to find a balance between meeting the needs of the client, the needs of the insurance company, and their own need to make a living. The framework for this struggle is our own professional code of ethics. Unfortunately, studies indicate that we do not always find our code of ethics to be especially useful when confronted with an issue arising from a conflict with the policies of an MCO. (Danzinger & Welfel 2001) While no one has suggested we do away with our code of ethics, several authors have suggested that mental health practitioners should broaden their ethical perspective. Doherty and Heinrich (1996) offer an alternative viewpoint: “the traditional, ethical gold standard—to ‘serve the patient's needs first’—is ecologically naive when considered out of systemic context, assuming as it does that one can abstract the needs of an individual from those of the broader community.” They suggest a model of ethical managed care that includes not just the patient and the clinician, but also the employer, the managed care organization, the government, and society. (Doherty & Heinrich 1996) While embracing a broader ethical perspective may well be necessary, “creating a balance between the perceived needs of clients and the perceived needs of costcutters in a society is no small task.” (Tjeltveit 2000) Since managed care does not seem likely to disappear any time soon, this is an issue that will continue to require mental health professionals to walk a fine line as they try to maintain an ethical balance.

References Belar, C. D. (2000). Ethical issues in managed care: Perspectives in evolution. The Counseling Psychologist, 28(2), 237-241. doi:10.1177/0011000000282002

Daniels, J. A. (2001). Managed care, ethics and counseling. Journal of Counseling & Development, 79(1), 119-122. doi:10.1002/j.1556-6676.2001.tb01950.x

Danzinger, P. R., & Welfel, E. R. (2001). The impact of managed care on mental health counselors: A survey of perceptions, practices and compliance with ethical standards. Journal of Mental Health Counseling, 23(2), 137-150. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2001-06542-005&site=ehost-live

Doherty, W. J., & Heinrich, R. L. (1996). Managing the ethics of managed healthcare: A systemic approach. Families, Systems, & Health, 14(1), 17-28. doi:10.1037/h0089819 Glosoff, H. L., Garcia, J., Herlihy, B., & Remley, T. P. J. (1999). Managed care: Ethical considerations for counselors. Counseling and Values, 44(1), 8-16. doi:10.1002/j.2161-007X.1999.tb00148.x

Gottlieb, M. C., & Cooper, C. C. (2000). The future of mental health care delivery: Ideals and realities. The Counseling Psychologist, 28(2), 263-266. doi:10.1177/0011000000282005

Moffic, H. S. (2004). Managed behavioral healthcare poses multiple ethical challenges for clinicians. Psychiatric Annals, 34(2), 98-104. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2004-11154-001&site=ehost-live

Strom-Gottfried, K. (1998). Is 'ethical managed care' an oxymoron? Families in Society, 79(3), 297-307. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=1998-02602-006&site=ehost-live

Tjeltveit, A. C. (2000). There is more to ethics than codes of professional ethics: Social ethics, theoretical ethics, and managed care. The Counseling Psychologist, 28(2), 242-252. doi:10.1177/0011000000282003

Younggren, J. N. (2000). Is managed care really just another, unethical model T? The Counseling Psychologist, 28(2), 253-262. doi:10.1177/0011000000282004