Healthcare ethics committees and managed care

Objectives: Healthcare ethics committees (HECs) play an important role in m edical decision making in US hospitals, but no study has determined whether HECs deal with managed care, in any form. This pilot study was performed t o evaluate the activities and perceptions of HECs about managed care. Study Design: Forty-five hospitals in the Philadelphia area were selected a t random, and comprised 36.6% of area institutions and 47% of area inpatien t beds. Surveys were administered to ethics committee representatives by th e authors in 1998. Patients and Methods: Survey responses were coded, and both tabulated respo nses and analyzed data are presented, Correlations were analyzed with the u npaired 2-tailed t test. Results: HECs devoted 7.6% of committee time to managed care issues, and th e remainder to education, policy development, and case consultation. Time s pent on managed care issues depended on the size of the institution (small hospitals spent twice the time on managed care as did large institutions); composition of the committee (presence of clergy and retirees on HECs corre lated with the likelihood that HECs would address managed care issues); and whether the HEC was requested to help with managed care issues. Of the HEC s surveyed, 18% had formal but disparaging discussions of ethical concerns in managed care. The impact of changing insurance programs on the hospital and HECs was a concern. Conclusions: HECs arbitrate ethical conflicts in managed care when asked. A s the presence of managed care increases, ethics committees will increasing ly be called on to resolve the resulting ethical dilemmas, To be effective in this role, HECs must become knowledgeable about managed care principles and policies.