To decide on whether or not an issue is considered ethical or moral we need the hard cold facts. Facts expose or explain what is to be decided upon—not what the outcome should be. Decisions regarding health care and mental health issues represent a major portion of ethical and moral choices. As individuals we are not always able to understand the justice, or fairness, behind the decisions supposedly based on hard cold facts.
Once upon a time being a therapist was considered a calling. The images of a counselor sitting back in their comfy cushioned chairs listening to hours and hours of patient's dilemmas, heartaches and mental health issues have been replaced with the hard cold facts that therapists today are fighting over customers while behaving according to appropriately mandated practices. HMOs (health maintenance organizations) and PPOs (preferred provider organizations) are the therapeutic callings today—managed care.
As therapists and patients it may be difficult to grasp the concept of "managed care" as this system becomes prevalent in the mental health areas. Managed care is any health care delivery system in which strategies are employed to optimize the value of provided services by controlling their cost, promoting their quality, and measuring performance to ensure cost-effectiveness. Managed care now dominates health care in the United States. A managed care system actively manages both the medical and financial aspects of a patient's care(Corcoran,1996).
Three concepts are at the origin of argument with managed care: control of the treatment plan, cost effectiveness, and quality of treatment. Current quality of care measurements focus on limited and tangible evidence. How do we measure evidence of mental health improvements? Who should make the decisions regarding mental health issues, the physician or the Chief Financial Officer? Health is an issue which needs be left to the physician while dollars and cents can remain with the financial officer. Managed care theoretically may seem appealing, but most view managed care practices as emphasizing cost control over quality.
The ethical arguments of managed care are dependent on the goals of the physician and the provider. If the primary goal is always doing the best for the patient within the limits of available resources and less interest for the bottom line then subjecting patients to unnecessary risks is minimal. However, if the patient is regarded as a secondary issue the physician and providers are ethically wrong. "It is the position of the National Academies of Practice that is unethical to compromise a patient's needs and quality care concerns to satisfy financial objectives" (Pope, K. S. & Vasquez, M. J. T., (1998) pg. 322).
The APA Ethical Principals of Psychologists and Code of Conduct (Section 4.09c) states, "Prior to termination for whatever reason, except where precluded by the patient's or client's conduct, the psychologist...