Clinicians and managed care companies will incur new legal duties as a result of their activities in a managed care environment The potential legal responsibilities of clinicians include the duty to appeal adverse decisions of a well managed care company; to discuss the potential economic consequences of treatment decisions; and to continue the treatment without payment or at a reduced rate. Clinicians may be reassured by the tendency of courts to recognize the legal responsibilities of both clinicians and care reviewers for their activities in managing the mental health care.
The United States laws in relation to managed mental health care organizations as follows; confidentiality issues; risk management; selection of providers; and the impact of rules relating to affiliated service groups. Some legal cases to demonstrate the areas in which a managed care organization may be held liable and makes some suggestions regarding ways those MMHPs can be structured and operated to maximize compliance with the State laws.
The core of the ethical debate in managing mental health care is the perceived trade-off between the goals of cost containment through management versus quality of care given to the patient, and the discipline of applied health care ethics to examine the implications of a well managed care for both provider, as well as to the consumer on the issues such as patient and provider autonomy, to informed the consent, of the “double agent” problem (the divided loyalty clinicians feel to both patient and care manager/payer).
In United States the success of well managed mental health care was based both on its quality and cost-effectiveness as well as on the extent to which the ethical issues are addressed and resolved satisfactorily. And the criticisms for concern managed care’s supposed adverse effects on its quality, limitations on access, and a loss of the provider/patient relationship, insufficient promotion of informed patient choice, heightened secrecy of policy and benefit design, and the transfer of decision-making responsibility from physicians to managers under utilization review processes.
In United States poor collaboration among health professionals leads to negative outcomes for patients and this problem was oversight by the authorities. The potential for revisions of the law, for the health care facilities was neglected and the application of research, professional collaboration, and the focused for training to maximize the collaboration between mental health care professionals, and the effectiveness of managed care was not given priority.
Today’s mental health clinician-administrators in both the public and private sector in United States face a number of ethical dilemmas. , such as patient rights, resource allocation, and problems posed by privatization of some of the managed care centers. A professional organizations was develops to organize ethical guidelines to assist administrators in monitoring and making difficult choices concerning the issues on all the health care centers.
The increased influence of a managed care center on the way the child and adolescent psychiatry is practiced has created new ethical and legal dilemmas for the clinician and administrator in the role of social values in medical decision making. Salient ethical issues are discussed, such as are current legal decisions addressing to the clinician responsibility within a managed care system. It is the duty of the child and adolescent psychiatrists to anticipate ethical dilemmas before starting their work with the hospital administrators to develop effective guidelines that address to the needs of the patient.