Cost Containment: Challenging Fidelity and Justice

Abstract

Cost containment heralds a general tightening of health care funds,\nwhich subjects every health care intervention to scrutiny for its economic as\nwell as its medical wisdom and imposes upon physicians a variety of controls\nand incentives. Fiduciary fidelity is challenged by the conflict between\nclinical authority and patient loyalty, by financial and professional\nincentives that pit the physician's own interests against those of his or her\npatients, by the stratification of resources which results in greater scarcity\nof funds for indigent care, and by standardization of care through the\nimplementation of "efficiency protocols." Questions of clinical justice are\nanalyzed in the areas of distribution of medical services and of contractual\nrelations among patient, payer, physician, and institution. (KIE\nabstract)