Peppin J F
Department of Internal Medicine, University of Osteopathic Medicine and Health Sciences, Des Moines, Iowa 50312, USA.
J Med Philos. 1999 Oct;24(5):535-50. doi: 10.1076/jmep.24.5.535.2518.
Managed care poses a challenge to the traditional conceptualization of medicine and of the physician-patient relationship. People have evaluated the merits of managed care by focusing upon the way its incentives alter the relationship between physician and patient. However, this misses the key to rightly evaluating MCOs. To address the ethics of MCOs one should focus on the institution-patient relationship, and this has not been sufficiently addressed in the literature. I will address this relationship here and show how the institution-patient relationship has evolved, why it has become increasingly prominent, and why we must move beyond business ethics for rightly understanding it.
管理式医疗对传统的医学概念以及医患关系构成了挑战。人们通过关注管理式医疗的激励措施改变医患关系的方式来评估其优点。然而,这忽略了正确评估管理式医疗组织(MCOs)的关键。要探讨管理式医疗组织的伦理问题,应该关注机构与患者的关系,而这在文献中尚未得到充分探讨。我将在此探讨这种关系,并说明机构与患者的关系是如何演变的,为何它变得越来越突出,以及为什么我们必须超越商业伦理才能正确理解它。