Managed care is promising because it could extend healthcare coverage to more people, but it must be watched to ensure that economic concerns don't outweigh basic values, Chicago's Cardinal Joseph Bernardin said last week.
Speaking at a meeting of the International Association of Catholic Medical Schools in Chicago, the outspoken Roman Catholic archbishop said rationing healthcare "may be justified by limits on resources."
In fact, the United States already rations healthcare by not adopting universal healthcare coverage, he said.
"Managed care offers the possibility of broadening access to healthcare through stretching government budgets and encouraging more employers to offer coverage," he said. But it "may require greater scrutiny to ensure that rationing decisions are transparent to patients and the public."
Bernardin has made four major addresses on healthcare in the past two years and has been one of the leading advocates of preserving the religious identity of Catholic institutions in a time of increasingly corporate healthcare. He recently threatened to strip a Chicago hospital of its Roman Catholic status because its managed-care strategy could hurt neighboring hospitals (Feb. 26, p. 3).
To be ethical,
rationing must meet a demonstrable need, reflect the common good and result from open debate, among other criteria, Bernardin said. For example:
*Practice guidelines must give patients a strong role in the decisionmaking process.
*Physicians and plan enrollees must be consulted in the development and adoption of protocols.
*Health plans must tell all enrollees about policies that limit care and physicians' financial incentives to control costs.
*Physicians must be free to discuss these issues with patients, and they should have an explicit role of advocacy for their patients.
As states move Medicaid beneficiaries into managed-care programs and limit access to care, they must do so because of a "genuine problem raising tax money" rather than because they have "decided for political expedience not to diminish some of their citizens' disposable incomes," Bernardin said. "Rationing in this context is unfair."