THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Thursday, May 2, 1996 TAG: 9605020420
SECTION: LOCAL PAGE: B3 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Medium: 66 lines
The rules of health care have changed, and patients need to know about the changes, said James F. Childress.
``It's only fair for people to know what kind of game they're playing,'' he said. Childress, a professor of religious studies and medical education at the University of Virginia, is a nationally known theologian medical ethicist.
He was at Norfolk's Eastern Virginia Medical School Wednesday to deliver the annual lecture sponsored by Friends of the Library at EVMS.
Childress, who spoke on ``The Ethics of Managed Care,'' said the responsibility for policing the ethics of a changing health care system rests with the community, not just the doctors, he said.
Managed care, an increasingly common system of health insurance, aims to reduce costs by limiting patient access to expensive, high-tech treatments and specialists, among other things.
It gives doctors incentives to reduce costs. A doctor is paid a set fee for every patient enrolled in a managed care program. In order to make money, the doctor must care for that patient for less than the set payment.
In theory, these incentives spur doctors to advocate healthy lifestyles and preventive medicine, and to stop ordering unnecessary tests and procedures just to get more money.
But the incentives also create conflicting obligations and interests, said Childress. A doctor - traditionally an advocate for the patient - now has obligations to the insurance company and to the other people in the plan to keep costs down. He and the other doctors in his practice also find their self-interest, making money, sometimes conflicts with the interest of the patient in getting the best care.
Society can take a hand in resolving these conflicts, Childress said. ``If corrected, there's no reason to think. . . managed care would be. . . intrinsically evil.''
The community can pass laws requiring insurance companies to divulge the details of financial arrangements with doctors, he said.
Some states have outlawed insurance company ``gag clauses'' - policies that forbid doctors from talking about these arrangements.
The gag rules have been justified with the time-honored ethical doctrine of confidentiality, he said.
But ``it's not now confidentiality between physician and patient, but between physician and managed care organization,'' he said. ``It's much closer to protecting trade secrets.''
Childress also pointed out the traditional system is far from flawless. Under that system, society uses military metaphors to describe health care - a ``battery of tests,'' a ``plan of attack'' - and approaches health care like an army waging a campaign.
This outlook urges doctors to favor fighting disease over preventing it; to focus more on the killers than the chronic illnesses; to pick high-tech over low-tech treatments. A mindset that sees death as the ultimate enemy leads to overtreatment, prompting social backlash like the right-to-die movement.
There are conflicts of interest under the traditional insurance arrangement. Because insurance companies paid for whatever the doctors ordered, there was a financial incentive to order more tests and treatment.
However, under that system, patients at least have access to information, since they can get a second opinion, he said.
KEYWORDS: MEDICAL ETHICS MEDICAL INSURANCE HEALTH INSURANCE by CNB