Managed competition and managed care. What are the ethical issues?

Managed competition and managed care, two hallmarks of President Clinton's health care reform proposal, would significantly change the way that health care in the United States is structured and delivered. This article presents ethical debates about managed care in historical perspective, reviews ethical arguments for and against managed care systems, and concludes with a set of practical guidelines to govern existing managed care arrangements. Throughout the paper, special attention is devoted to the impact of managed care on the elderly population and on physician-patient relationships.