5) Ethical Issues

A. Quality Considerations

As managed care systems assume a larger role in health care, it is important that nurses strive to promote and preserve the ethical precepts of the profession and remain committed to the delivery of compassionate, competent, respectful and responsible care. Nurses repeatedly express concern over the impact of managed care and restructuring on the quality and safety of patient care, and the difficulty in fulfilling their advocacy responsibilities to patients. The obligation to safeguard patients and minimize harm is greatly challenged in the present health care environment.

B. Increasing Profits and CEO Salaries

The increasing profitability of managed care organizations, and the rising salaries of their top administrators, are major ethical issues for consumers, nurses and other providers. Managed care organizations and health care institutions assert that cost-control must be an increasing priority, and that the advantage of managed care is its ability to provide care more efficiently and cost-effectively. One could question whether, in an environment in which everyone is asked to share the economic burdens of health care delivery, there is room for increasing profiteering and for outrageously high administrative salaries? Why should deal-making in the health care industry yield bonuses in the millions of dollars? Why are these savings not shared with the plan participants in terms of either enhanced services or reduced premiums? How can these abuses be reconciled with the continual claims for harsher austerity measures, including nurse layoffs, in the health care industry?

These questions may be sardonic, but they help to make a point. This is an industry out of control, in which nurses and consumers alike are told to make do with less, by a system that is making a people into millionaires many times over. Is this what we want in a health care system?

C. Emerging Compensation Systems

Managed care organizations have examined means to provide professionals with financial incentives to keep costs low. Some have offered physicians bonuses for keeping expenses down or limiting referrals to specialists. Some HMO-run hospitals have experimented with compensation systems that reward lower expenses or higher levels of patient satisfaction. ANA has expressed its concern with providing financial incentives to limit care.

Nursing has long recognized the value of ensuring more efficient, less wasteful use of resources. What indicator can be used to separate legitimate efforts to use resources more efficiently from those that provide nurses (or others) with a financial stake in withholding care? This question gains significance for the nursing profession as new approaches to compensation continue to emerge. ANA continues to work to provide guidance in assessing these new compensation systems.

These are just a few of many important policy issues raised by managed care. ANA has placed high priority on addressing the impact of managed care on the quality and safety of health care and the impact on the employment opportunities and working conditions of registered nurses. ANA's Congress on Nursing Practice has convened a workgroup of nurses with expertise in existing managed care regulations and current operations, to review the National Committee on Quality Assurances (See http://www.ncqa.org) accreditation process for managed care organizations as well as all other pertinent regulations. The committee is charged with identifying nursing's recommendations for the essential elements of managed care regulation, and preparing a policy briefing paper that will identify areas not addressed in current regulations.