HOW To Heal Managed Care
Connor, James L.
HOW TO HEAL MANAGED CARE Health care is not a business James L. Connor 11 of a sudden, the managed health-care system mas. HMO horror stories...
...He also decides to tap the regional center's physician world of managed care...
...My general prescription is a strong institutional sense that the business of health care is not business...
...The regional center is four hundred miles and death...
...With Jason's story hitting the press, an appeal tient and provider is not simply an economic transaction...
...leaders, I have come to know a fair number of them...
...At the Woodthat means competition and the drive toward market share stock Theological Center at Georgetown University in Washand profits or revenue (pressures applying to nonprofit as well ington, we brought together fifty-four health-care practitionas for-profit systems in today's health-care environment...
...What I Revelation in Cultural Context" find more revealing is the process of ethical decision making • REV...
...What should he do...
...CAROLYN OSIEK "Family Life in the World of publicly available mission statement of the HMO...
...The Martins, a family of modest means, have health insurThe bane of health care today is the illusion that it's a busi- ance through a managed-care organization...
...According to this fallacy, delivering health treatment center is outside the network of providers, and the care is like making widgets or Nike sneakers...
...As a priest and ethicist who reaches out to business port to the value-laden process of arriving at those decisions...
...Mary of the Lake care organizations can drive home the message and steer the 1000 E. Maple Ave.• Mundelein, IL 60060 case-by-case deliberations with functional mission statements...
...rather than as ends themselves...
...ers, industry leaders, and policy experts who grappled with The paradox is that by playing this game so exceedingly well, HMOs are losing it...
...GAIL O'DAY "Conflicting Images: The Book of pect there wasn't a single "right choice" in this case...
...care leaders and practitioners must think of themselves as For information and registration contact: pursuing not just a career but a calling-a "profession" in Center for Development in Ministry the venerable sense of the word...
...Everything else, including shareholder scenarios like this one...
...One key is to focus on the "how" Organizations, managed-care executives are the new bad of decision making, not just the "what" or results...
...A gun manufacturers, and asbestos makers...
...In business, turned public wrath on the HMO industry...
...O Commonweal 18 February 25, 2000...
...Communal prayer that integrates with the presentations...
...But all of us, esexcruciating moral mazes of contemporary American busi- pecially health-care providers, should give greater ethical imness...
...It strikes at the very ical director with a solid commitment to delivering high-qualessence of human well-being...
...Stanleys are out there in the brave new network...
...It came down to a gut feeling, based on the limScripture Institute at Mundelein ited evidence he had, that Jason might have a chance to get an "Sacred Scripture and Cultural Transformation" additional twenty-four months of life with the new therapy," the panel said in its report Ethical Issues in Managed Health Week 1: June 18-23 Care Organizations (Georgetown University Press...
...BRUCE MALINA "Reading the New Testament in holders include patients and their families, physicians, emSocial Context" ployers who sponsor health plans, and, in the case of for• REV...
...This often-colliding values and priorities...
...Stanley make the right choice...
...The center sponsors an ongoing under your HMO...
...An amazingly beautiful campus and awesome natural setting...
...Decision makers in the system need to begin cultivating the habit of ethical deliberation...
...If managed care wants to rekintion in the Acts of the Apostles" dle the trust of all stakeholders and the larger public, such a Special Features: process needs to become the norm, not the exception...
...The moral drama of Jason Martin's case lies in the med- Within such an explicit ethical framework, managed care ical director's methodical mulling of questions that spotlight must also build a corporate culture of transparency...
...in the recent stories of HMO horror, these tales reveal an During seminar meetings, participants acted the parts of institution in crisis...
...HOW TO HEAL MANAGED CARE Health care is not a business James L. Connor 11 of a sudden, the managed health-care system mas...
...Most people, of organization has refused to cover the costly, experimental course, don't think so...
...has tended to dwell on yes-or-no decisions in contested cases There are surely some venal people in managed care, as of managed care, involving medical procedures such as authere are in all sectors of society, including organized reli- tologous bone marrow transplants for women with advanced gion...
...As How does one deliberate over decisions that can so rapidicons of the near-universal loathing of Health Maintenance ly descend into HMO hell...
...der chance of success, against the burden of further treatment Organized religion has a distinct role in helping all of us, and the hardship of separation during what might be their especially the desperately ill, come to terms with suffering son's final days...
...Institutionally, managedUniversity of St...
...eration so long as they cling to the illusion that health care is just a business, trading in a precious commodity...
...Stanley, a medhuman interaction, a relationship of care...
...Commonweal 17 February 25, 2000 as a consultant...
...Congress is wielding a bipartisan hammer of legislation, physicians are unionizing, and the specter of costly malpractice lawsuits is haunting managed care organizations...
...LARRY BOADT, CSP "The Old Testament as that yielded this result...
...I sus• DR...
...The public guys in television dramas and movies like As Good as It Gets...
...The cases that come before these people are usually resame level of popularity as tobacco companies, sistant to easy moralizing...
...What the HMO horror shows usually overlook, how- breast cancer and lung volume reduction surgery for patients ever, is that these executives are operating in one of the more with advanced chronic pulmonary disease...
...Would employers pass on the charges to their Amid the groundswell of demand for a "Patients' Bill of workers, or trim health benefits to hold down costs...
...Stanley's could conceivably take the public form of annual "ethical aumanaged-care organization has a policy of not covering treat- dits" ranking the values and priorities that drive decision ment that is experimental or outside the network of providers...
...Obviously, HMOs won't foster this habit of ethical delib• Schedule that allows you time to relax and pray...
...It's a by the parents has landed on the desk of Dr...
...StakeJesus/in the Early Church" • DR...
...For example, Dr...
...DR...
...Stanley's own staff...
...In the end, Dr...
...seminar in business ethics...
...Though there may be fictional strands job...
...it's care of health...
...Would a choice to send the family outside the often has diminishing returns, especially in the final months network betray a lack of confidence in Dr...
...All healthCost: $475 per week...
...Essentially, what the medical director Book: The Old Testament as Lectionary" did was probe the legitimate claims-and values of the varWeek 2: June 25-30 ious so-called stakeholders and weigh them in light of the • SR...
...Phone (847) 566-8290 • FAX (847) 566-7971 These statements must say plainly that the goal of health care is caring for health...
...scends, and trumps, their deepest values...
...JOSEPH FITZMYER, S.J...
...My friends in managed care un- ity, appropriate care...
...But they work in a corporate culture that often tran- cer-fighting drug being tested several hundred miles away...
...Ultimately, patients need to factor death into the human Furthermore, have Jason's parents really weighed the slen- equation...
...Over the past two years, they have return and executive compensation, should be understood met periodically for seminar-style meetings to check the eth- as practical means toward the delivery of quality health care ical pulse of managed care...
...They have an obligation to understand cancer-fighting drug, though less promisingly than at the re- that medical resources are finite, and that exotic treatment gional center...
...derstand this, on some deep level...
...It is a crisis of moral legitimacy...
...of life...
...As a Let's examine a composite case: Eight-year-old Jason Marwhole, they're very decent people who want to do the right tin has a deadly brain tumor and one last hope-a new canthing...
...Would more patients insist on exotic and un- the salvation of managed care at a time when the system proven procedures, possibly escalating the costs of employee seems hell-bound in the public's judgment...
...Stanley de- ical fortunes of this ailing system may well depend on how cides to cover the experimental treatment but only within the many real-life Dr...
...HMO horror stories aside, these are indeed moral dilemin the United States finds itself at roughly the mas...
...That's because the encounter between pa- drug therapy...
...and for that, they need a corporate climate that encourages discussion of their dilemJames L. Connor, S.J., is director of the Woodstock Theological "Laughter is the best medicine, but it's not covered Center at Georgetown University...
...Cultural Transforma- profit systems, shareholders...
...The panelist who role-played the good docThe 27th Annual tor is, in fact, a medical director of a large managed-care organization...
...But they also understand The account-though fictional-is of the kind that has the game they're in, and must play by its rules...
...But the regional ness like any other...
...What managed care could use is a careful dose of moral perspective, for its own survival as well as for the greater good...
...Death does not have the last word in the unaway, and Jason's father would have to stay behind at his bounded book of life...
...I don't know...
...JOHN PILCH "Jesus the Holy Man: Healing and Cultural Transformation" Did Dr...
...Openness and transparency can be precedent...
...making and, within limits of confidentiality, disclosing how Would granting an exception in Jason's case create a harmful tough cases were resolved...
...Rights," we should also remember that patients have reThe organization's oncologists have begun testing the same sponsibilities, too...
...health plans...
...The eththese and other "stakeholders...
Vol. 127 • February 2000 • No. 4
