Biomaterial Database

The ethics of providing intensive care in managed care organizations. 1997

M Danis, and L Churchill

Department of Medicine, University of North Carolina at Chapel Hill 27599-7110, USA.

To provide adequate and equitable care of critically ill patients, managed care organizations need to dedicate a reasoned proportion of organizational resources to the provision of critical care, distribute these resources fairly, establish appeal mechanisms, and monitor the outcomes of critical care. As in any healthcare delivery system with limited resources, it is inevitable that there will be limits to highly technological and costly life-sustaining care. Patients, physicians, and plan administrators will need to collaborate to decide priorities for care, since difficult trade-offs will need to be made between types of care and between quality and cost of care. The use of life-sustaining treatments should be informed by patient preferences and guided by many of the established guidelines for the provision of critical care. Physicians who provide critical care in a managed care organization should provide the most skilled and compassionate care to critically ill patients within the constraints of the ethically acceptable guidelines.

UI	MeSH Term	Description	Entries
D008020	Life Support Care	Care provided patients requiring extraordinary therapeutic measures in order to sustain and prolong life.	Extraordinary Treatment,Prolongation of Life,Care, Life Support,Extraordinary Treatments,Life Prolongation,Treatment, Extraordinary,Treatments, Extraordinary
D008329	Managed Care Programs	Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.	Case Management, Insurance,Insurance Case Management,Managed Health Care Insurance Plans,Managed Care,Care, Managed,Managed Care Program,Management, Insurance Case,Program, Managed Care,Programs, Managed Care
D010819	Physician's Role	The expected function of a member of the medical profession.	Physicians' Role,Physician Role,Physician's Roles,Physicians Role,Physicians' Roles,Role, Physician's,Role, Physicians',Roles, Physician's,Roles, Physicians'
D011787	Quality of Health Care	The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.	Pharmacy Audit,Quality of Care,Quality of Healthcare,Audit, Pharmacy,Care Quality,Health Care Quality,Healthcare Quality,Pharmacy Audits
D002983	Clinical Competence	The capability to perform acceptably those duties directly related to patient care.	Clinical Skills,Competence, Clinical,Clinical Competency,Clinical Skill,Competency, Clinical,Skill, Clinical,Skills, Clinical,Clinical Competencies,Competencies, Clinical
D003363	Cost Control	The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)	Cost Containment,Containment, Cost,Containments, Cost,Control, Cost,Controls, Cost,Cost Containments,Cost Controls
D003422	Critical Care	Health care provided to a critically ill patient during a medical emergency or crisis.	Intensive Care,Intensive Care, Surgical,Surgical Intensive Care,Care, Critical,Care, Intensive,Care, Surgical Intensive
D004991	Ethics, Institutional	The moral and ethical obligations or responsibilities of institutions.	Ethics, Health Facility,Ethics, Hospital,Ethics, Organizational,Organizational Ethics,Health Facility Ethics,Hospital Ethics,Institutional Ethics,Institutional Obligations,Ethic, Health Facility,Ethic, Hospital,Ethic, Institutional,Ethic, Organizational,Facility Ethic, Health,Facility Ethics, Health,Health Facility Ethic,Hospital Ethic,Institutional Ethic,Institutional Obligation,Obligation, Institutional,Obligations, Institutional,Organizational Ethic
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.