Moses H
Clin Perform Qual Health Care. 1996 Oct-Dec;4(4):200-2.
Managed care creates several dilemmas for the physician executive. Effective management is hindered by lack of analytical tools that stem from current limitations in outcomes research and treatment protocols, altered financial incentives that are controversial and that seem at odds with traditional incentives, and values that create conflict between the needs and expectations of individual patients and populations or groups under managed care. The executive must manage a process that resolves apparent conflict in an explicit ethical framework that acknowledges the limitations of data, with full awareness of the potential conflict between financial incentives and clinical judgement.
管理式医疗给医师管理人员带来了几个两难困境。有效的管理受到多种因素的阻碍，包括源于当前结果研究和治疗方案局限性的分析工具匮乏、存在争议且似乎与传统激励措施相悖的财务激励措施改变，以及在管理式医疗下个体患者需求与期望和人群或群体需求与期望之间产生冲突的价值观。管理人员必须在一个明确的道德框架内管理一个解决明显冲突的过程，该框架承认数据的局限性，同时充分意识到财务激励措施与临床判断之间的潜在冲突。
