BUS FPX 4121 Assessment 2 External Forces and Ethical Challenges

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Capella University

BUS-FPX4121 Ethics in Health Care Management

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Date

External Forces and Ethical Challenges

Healthcare systems are increasingly shaped by economic and external forces, which lead to several challenges. These challenges include the growing demand for healthcare services, limited availability of healthcare providers, and the scarcity of facilities, all of which are influenced by the rising costs associated with healthcare (Morrison, 2020).

Managed Care

Managed care, which emerged in the 1980s, was designed to improve patient care while controlling the costs of medical services and increasing profitability. One of the main goals of managed care is to ensure equitable access to healthcare services while keeping expenditures manageable (Morrison, 2020). Over the years, managed care has had a positive impact on healthcare by providing patients with access to necessary services at reduced costs (Shrank, Keyser, & Lovelace, 2018). However, managed care plans also have limitations, particularly in terms of restricted access to healthcare providers and the requirement for referrals, which can present ethical dilemmas for healthcare professionals (Shrank et al., 2018). Despite these challenges, managed care coverage has expanded significantly in recent decades (MACPAC, 2022).

Ethical Challenges in Managed Care

A primary ethical challenge in managed care is accessibility. Limitations on provider availability can interfere with delivering the most effective treatment to patients. Healthcare professionals must navigate ethical principles such as autonomy, beneficence, non-maleficence, and justice when dealing with these limitations, ensuring that patients’ rights and needs are prioritized (Morrison, 2020; Vrijhoef, 2022).

Recommendations

To address these ethical challenges, short-term strategies could include authorizing out-of-network providers when necessary based on the patient’s care needs. In the long term, expanding the network of managed care providers would enhance the availability of in-network services, addressing the concerns regarding accessibility and fairness (Morrison, 2020).

Conclusion

Although managed care has led to improvements in healthcare delivery, its restrictions on provider access pose ethical challenges. By expanding the managed care network, healthcare systems can mitigate these concerns and ensure that patients receive the care they need, regardless of their health plan’s limitations (Morrison, 2020).

References

Ethical Issues in Managed Care. (n.d.). Retrieved from https://www.amihm.org/ethical-issues-in-managed-care/

MACPAC. (2022, March 10). Medicaid Managed Care Capitation Rate Setting. Retrieved from https://www.macpac.gov/publication/medicaid-managed-care-capitation-rate-setting/

Morrison, E. E. (2020). Ethics in health administration: A practical approach for decision makers (4th ed.). Jones & Bartlett. Chapters 6–7.