Managing Care

Part 1. Health care costs and scarcity. 1. Introduction. 2. Development of Managed Care. 2.1 The concepts of 'costs'. 2.2 Economic restraints. 3. Rationing: A dilemma for ethicists. 3.1 Scarcity is an economic reality. 3.2 Ethics and rationing. 3.3 Medical necessity. 3.4 Cost effectiveness and cost benefit analysis. 3.5 Affordability. 3.5 A comprehensive approach. 3.6 Talking about responsibility. 4. Responsibility. 4.1 What is the distribution claim made by agency theories? 4.2 Normative weakness. 4.3 Responsibility: the key notion. 4.4 'Genuine responsibility' as a proposal for a unifying paradigm. Part 2. The concept of managed care and its practical implications. 1. Introduction. 2. Quality of Care in Managed Care. 2.1 Fairness in managed care. 2.2 Public distrust. 3. History of Managed Care. 3.1 Economic Pressure. 3.2 Medical Waste as a Contributor to Cost. 4.Where does managed care find its market. 5. Definition of managed care. 5.1 Different forms of managed care. 5.2 Implications of managed care. 5.3 Characteristics of managed care. 5.4 Expectations and disappointments. 6. Managed care as unknown territory. 6.1 Distribution by managing outcomes. 6.2 Utilization versus best practice data. 6.3 What ought to be versus what is. 7. Methodological concerns regarding data collection. 7.1 Normative concerns about data. 8. Population-based distribution and individual autonomy. 8.1 Reconsidering medical paternalism. 8.2 Foundation of a rights-orientated health care. 9. Balancing responsibilities. 9.1 Denial of liability and accountability. 9.2 Responsibility of MCOs to members. 10. Changes in managed care. 10.1 The obvious question. Part 3. Ideology: the silent partner. 1. Introduction. 2. The concept of ideology. 3. Ideology in medicine. 3.1 Ideological components in the definition of health. 3.2 Models of causation of disease and their ideological relevance. 4. The context of scarcity and its ideological impact on health care. 4.1 The ideological context of the model of rationing and its symbolicy forms. 5. Conclusion. Part 4. Concept of Genuine Responsibility. 1. Introduction. 2. Changing the focus in health care distrisbution. 2.1 Unlimited access versus cost containment. 2.2 An analogy. 2.3 An ethics approach. 2.4 Rationality and Empathy. 3. The notion of responsibility. 3.1 An ethics of genuine responsibility. 3.2 The definition of 'Genuine Responsibility'. 3.3 Implications on the notion of personal responsibility. 4. Justice and health care. 4.1 Just health care. 4.2 The odds of just health care. 4.3 Impediment to justice. 5. Key presumptions. 5.1 Challenging the notion of responsibility in managed care. 5.2 Health care distribution in a free-market economy. 5.3 Justice as appropriation. Part 5: Revising the template for modeling health care. 1. Introduction. 2. Necessity for change. 2.1 Rec