This Article Reprint (PDF) Submit a response to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Archive Download to Citation Manager Reprints & Permissions Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (75) Citing Articles via Google Scholar Google Scholar Articles by Daniels, N. Articles by Sabin, J. Search for Related Content PubMed PubMed Citation Articles by Daniels, N. Articles by Sabin, J. Related Collections Ethical Issues Health Reform Managed Care

Health Affairs, Vol 17, Issue 5, 50-64
Copyright © 1998 by Project HOPE

Journal Article

The ethics of accountability in managed care reform

Two notions of accountability embodied in proposals to reform managed care have different ethical implications. Market accountability requires plans to inform purchasers and consumers about performance and options, in theory legitimizing limits to care through consumer choice. Recognizing the limits of consumer choice, accountability for reasonableness requires that the rationales for limits to services be public and be based on reasons or rules that "fair-minded" people can agree are relevant to pursuing appropriate patient care under necessary resource constraints. Accountability for reasonableness educates clinicians and patients about the need for limits and empowers a more focused public deliberation in which ultimate authority for limiting care rests with democratic processes.

                      What's this?

This article has been cited by other articles:

				M Schlander The use of cost-effectiveness by the National Institute for Health and Clinical Excellence (NICE): no(t yet an) exemplar of a deliberative process J. Med. Ethics, July 1, 2008; 34(7): 534 - 539. [Abstract] [Full Text] [PDF]

				B. Sharma, N. M. Danjoux, J. L. Harnish, and D. R. Urbach How Are Decisions to Introduce New Surgical Technologies Made? Advanced Laparoscopic Surgery at a Canadian Community Hospital: A Qualitative Case Study and Evaluation Surgical Innovation, December 1, 2006; 13(4): 250 - 256. [Abstract] [PDF]

				J. R. Teagarden and M. K. Wynia Ensuring fairness in coverage decisions: Applying the American Medical Association Ethical Force Program's consensus report to managed care pharmacy. Am. J. Health Syst. Pharm., September 15, 2006; 63(18): 1749 - 1754. [Full Text] [PDF]

				S. Peacock, D. Ruta, C. Mitton, C. Donaldson, A. Bate, and M. Murtagh Using economics to set pragmatic and ethical priorities. BMJ, February 25, 2006; 332(7539): 482 - 485. [Full Text] [PDF]

				C. M. Flood Just Medicare: The Role of Canadian Courts in Determining Health Care Rights and Access J. Law Med. Ethics, December 1, 2005; 33(4): 669 - 680. [PDF]

				J. Manning and R. Paterson "Prioritization": Rationing Health Care in New Zealand J. Law Med. Ethics, December 1, 2005; 33(4): 681 - 697. [PDF]

				E C Winkler The ethics of policy writing: how should hospitals deal with moral disagreement about controversial medical practices? J. Med. Ethics, October 1, 2005; 31(10): 559 - 566. [Abstract] [Full Text] [PDF]

				T. A. Brennan and T. H. Lee Allergic to Generics Ann Intern Med, July 20, 2004; 141(2): 126 - 130. [Abstract] [Full Text] [PDF]

				G. J. Povar, H. Blumen, J. Daniel, S. Daub, L. Evans, R. P. Holm, N. Levkovich, A. O. McCarter, J. Sabin, L. Snyder, et al. Ethics in Practice: Managed Care and the Changing Health Care Environment: Medicine as a Profession Managed Care Ethics Working Group Statement Ann Intern Med, July 20, 2004; 141(2): 131 - 136. [Abstract] [Full Text] [PDF]

				N. Daniels and J. Sabin Comment Clinical Trials, February 1, 2004; 1(1): 116 - 117. [PDF]

				J. E. Sabin, M. F. O'Brien, and N. Daniels Managed Care: Strengthening the Consumer Voice in Managed Care: II. Moving NCQA Standards From Rights to Empowerment Psychiatr Serv, October 1, 2001; 52(10): 1303 - 1305. [Full Text] [PDF]

				J. E. Sabin and N. Daniels Managed Care: Strengthening the Consumer Voice in Managed Care: I. Can the Private Sector Meet the Public-Sector Standard? Psychiatr Serv, April 1, 2001; 52(4): 461 - 464. [Full Text] [PDF]

				N. Daniels Accountability for reasonableness BMJ, November 25, 2000; 321(7272): 1300 - 1301. [Full Text]

				P. A Singer, D. K Martin, M. Giacomini, and L. Purdy Priority setting for new technologies in medicine: qualitative case study BMJ, November 25, 2000; 321(7272): 1316 - 1318. [Abstract] [Full Text]

				J. E. Sabin Managed Care and Health Care Reform: Comedy, Tragedy, and Lessons Psychiatr Serv, November 1, 2000; 51(11): 1392 - 1396. [Full Text] [PDF]

				J. E. Sabin and N. Daniels Managed Care: Public-Sector Managed Behavioral Health Care: VI. The Iowa Approach to Profit and Community Reinvestment Psychiatr Serv, October 1, 2000; 51(10): 1239 - 1247. [Full Text] [PDF]

				P. A Singer Recent advances: Medical ethics BMJ, July 29, 2000; 321(7256): 282 - 285. [Full Text]

				J. E. Sabin and N. Daniels Ethics and Managed Care Psychiatr Serv, March 1, 2000; 51(3): 393 - 393. [Full Text] [PDF]

				R. McEldowney and W. L. Murray Not Just for Bureaucrats Anymore: Bureaucrat Bashing, Overhead Democracy, and Managed Care Administration Society, March 1, 2000; 32(1): 93 - 110. [Abstract] [PDF]

				C. Ham Tragic choices in health care: lessons from the Child B case BMJ, November 6, 1999; 319(7219): 1258 - 1261. [Full Text]

				J. E. Sabin and N. Daniels Managed Care: Public-Sector Managed Behavioral Health Care: IV. Integrated Versus "Carve-Out" Care Psychiatr Serv, October 1, 1999; 50(10): 1267 - 1280. [Full Text] [PDF]

				J. E. Sabin and N. Daniels Managed Care: Public-Sector Managed Behavioral Health Care: III. Meaningful Consumer and Family Participation Psychiatr Serv, July 1, 1999; 50(7): 883 - 885. [Full Text] [PDF]

				J. E. Sabin and N. Daniels Managed Care: Public-Sector Managed Behavioral Health Care: II. Contracting for Medicaid Services-the Massachusetts Experience Psychiatr Serv, January 1, 1999; 50(1): 39 - 41. [Full Text] [PDF]

				E. C. Ross Regulating Managed Care: Interest Group Competition for Control and Behavioral Health Care Journal of Health Politics Policy and Law, January 1, 1999; 24(3): 599 - 625. [Abstract] [PDF]

				R. Klein Puzzling out priorities BMJ, October 10, 1998; 317(7164): 959 - 960. [Full Text]

				S. Holm, J. E Sabin, D. Chinitz, C. Shalev, N. Galai, and A. Israeli The second phase of priority setting • Goodbye to the simple solutions: the second phase of priority setting in health care • Fairness as a problem of love and the heart: a clinician's perspective on priority setting • Israel's basic basket of health services: the importance of being explicitly implicit BMJ, October 10, 1998; 317(7164): 1000 - 1007. [Full Text]