摘要:

Until recently, many Americans have been satisfied with their health care and the insurance system that pays for it. Since the early 1990s, however, concerns have arisen about the uneven distribution of medical care and its spiraling costs. Systems of managed care have evolved rapidly in the belief that they ensure that care is comprehensive, coordinated, and cost-effective. Reforms in health care legislated by individual states and at the federal level have spurred growth of managed care and profoundly impacted medical practice. Many hospitals have closed or merged with one another. Consumers have complained about premature discharge from institutions, inconvenience of medical services, changes in the physician- patient relationship, and insufficient access to specialists for treatment of complicated conditions. Managed care plans have competed primarily on the basis of price rather than quality. Most have objected to outcome measures that focus on whether patient health and function improve as a result of treatment. Extensive changes in the health care environment have confronted practitioners with practical and ethical dilemmas.

ISSN:0885-9701    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Recent developments in the organization of health care services and financing, usually subsumed within the category of managed care, seem to be altering the character of the providing institutions. The purpose of this presentation is (1) to clarify what managed care is and what the operating assumptions are of those who advocate for it; (2) to examine the impact of managed care, and the associated assumptions, on the character of and moral analysis within nongovernmental health care institutions; and (3) to suggest possible correctives to the negative aspects of managed care, while acknowledging the numerous benefits. The preferred corrective is the “community of care,” an institutional model based on value-centered organizational identity.

ISSN:0885-9701    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

One of the most important moral achievements of contemporary American health care is the institutlonalization of informed consent. Despite its paternalistic past, American medicine in the 1960s began to embrace the right of all patients to accept or reject medical treatments. Patients were offered choices on the basis of increasingly comprehensive disclosures of treatment options and their attendant risks, including the option of no treatment at all. Informed consent was grounded in autonomy, itself an expression of respect for human dignity. The rapid spread of managed care arrangements through the 1990s has jeopardized this achievement. Because of its financial incentives, managed care threatens to reverse the achievements of informed consent. For a number of reasons related to the very nature of rehabilitation, the threat to informed consent in this arena is greater yet. If the benefits of a professional and cultural consensus on informed consent are to be sustained for another generation, active steps will have to be taken to protect it in the managed care environment.

ISSN:0885-9701    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Everywhere one looks in health care, concern is being expressed about the ethical issues raised by efforts to contain costs. Managed care bears much of the brunt of these concerns. Many health policy analysts argue that the central issue raised by the need to contain costs is the need to arrive at a set of rules or principles that will permit the fair and equitable allocation of resources. However, the main moral challenge posed by cost containment is not arriving at agreed-upon principles. Rather, it is the moral dilemma created when health care providers are asked to serve in the roles of both bedside patient advocate and guardian of societal resources. This is especially true in the field of rehabilitation medicine, where patients often cannot protect their own interests due to impairments of competency or loss of freedom as a result of institutionalization, or because they find it hard to deal with the team approach, In which the locus of authority can be difficult to determine.

ISSN:0885-9701    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Tills article deals with concerns and ethical dilemmas of physiatrists who specialize in brain Injury rehabilitation in a managed care environment. Challenged to provide daily cost-effective care in a quality manner, physiatrists have become Increasingly concerned with their clinical decision-making autonomy and with perceptions of changing standards in clinical care. This article explores these concerns and raises potential solutions that may help manage them.

ISSN:0885-9701    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Outcome-oriented rehabilitation is a cost-effective and qualitative method for identifying and obtaining realistic outcome results from rehabilitation. The model of outcome-oriented rehabilitation is an optimal way of conceptualizing, organizing, and delivering rehabilitation within a managed care environment. The approach acknowledges the central role of the consumer In identifying and building the rehabilitation outcome plan. As we move into the future, health care and rehabilitation providers must be willing to assume responsibility and accountability for results. Outcome-oriented rehabilitation is based on shared accountability among the primary stakeholders for results. The purpose of this article is to review the principles of outcome-oriented rehabilitation and the implications for brain injury rehabilitation.

ISSN:0885-9701    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A terrific collaborative opportunity exists today for providers and payers of neurorehabilitation services to benefit from one another's initiatives and creativity. That opportunity will be realized when providers and payers candidly address each others' business and clinical missions and also issues of societal and moral obligations (ie, ethical concerns). To date, these discussions have been limited or nonexistent. Substantial existing data document the clinical effectiveness of neurorehabilitation services, which, in an era of managed health care, provide a financial opportunity for the payer community. This article presents a framework by which providers and payers of neurorehabilitation services can initiate discussions and reap mutual benefits.

ISSN:0885-9701    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This article examines how contemporary values emphasizing personal rights that in turn give rise to an ideology of robust individualism have exerted enormous influence in contemporary health care, especially in the allocation of rehabilitation services. The points of influence to be examined include the ways in which contemporary values discourage a sense of mutual obligation and shared responsibilities, alienate persons with disability from accessing opportunity, inspire and justify the contemporary phenomenon of managed care, and subordinate rehabilitation's time-honored goal of restoring function to a goal of economic feasibility. Suggestions are made for remedying these challenges, although an ideal solution will at least require a heightened appreciation of how the notion of shared social obligations enhances the pursuit of self-interest, especially when that pursuit is threatened by the onset of disability.

ISSN:0885-9701    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1997

数据来源: OVID