Managed Care and Undividing Loyalties

Managed care is often faulted for requiring physicians to abandon their traditional fiduciary responsibility to individual patients. Physician loyalty is said to be divided between a concern for patient benefit on the one hand and for financial advantages accruing to the physician personally or to the group of plan participants on the other. A recent U.S. Supreme Court case has supported this development by deciding that physicians are now responsible to function simultaneously as clinical caretakers and benefits administrators. It is granted that this situation gives rise to legitimate concerns about the potential for undermining patient trust in physicians and yet there are also reasons to believe that this is a step in the right direction. Specifically, by requiring doctors to make "mixed" treatment and eligibility decisions, the Court has pointed the way for people to think and make decisions about health and health care without abstracting from the cost of that care.