Considerations for ethical practice in managed care

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psycholo gists are increasingly raising such questions about ethical issues when wor king in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and foc us on 4 areas in which ethical dilemmas most commonly arise in a managed ca re context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advoca cy efforts to ensure patient access to quality health care is discussed as is the impact of managed care's competitive marketplace on professional rel ationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic eth ical decision making.