HEALTH OUTCOMES AND MANAGED CARE - DISCUSSING THE HIDDEN ISSUES

Too often the debate over health outcomes and managed care has glossed over a series of complex social, political, and ethical issues. Excit ing advances in outcomes research have raised hopes for logical medica l reform. However, science alone will not optimize our patients' healt h, since value judgments are necessary and integral parts of attempts to improve health outcomes within managed care organizations. Therefor e, to form healthcare policy that is both fair and efficient, we must examine the fundamental values and ethical concerns that are imbedded in our efforts to shape care. We must openly discuss the hidden issues including: (1) trade-offs between standardization of care and provide r-patient autonomy; (2) effects of financial incentives on physicians' professionalism; (3) opportunity costs inherent in the design of insu rance plans; (4) responsibilities of managed care plans for the health of the public; (5) judicious and valid uses of data systems; and (6) the politics of uncertainty.