Professionals working with managed care are consistently confronted with the ethical dilemmas inherent in managed behavioral healthcare. Moffic, a professor of psychiatry, takes the reader through the formation of a hypothetical managed behavioral healthcare organization. He teases out the intricacies of competing ethical standards present in behavioral healthcare.

Clearly the push-pull of business and medical ethics are foundational struggles in managed care. Moffic details ethical considerations from the initial philosophical basis of the organization to the various issues presented by such responsibilities as medical necessity, informed consent, confidentiality, financial influences, treatment and utilization review.

Moffic presents his information in a story form. He introduces characters, describing their significance and contribution to resolving ethical considerations. It is not always clear in the story telling when Moffic is drawing upon factual information. On several occasions, it was necessary to sort out this issue to determine if the information was certifiable or conjecture. Relying on impeccable qualifications regarding managed care; Moffic takes the reader into a discussion between co-owners who start a managed care organization based on ethical standards. Problems arise throughout the dialogue representing the complexity of business and healthcare ethics.

Examining these issues provide an opportunity to ask hard questions facing healthcare reform today. Managed care organizations are faced with a daunting task of balancing fiscal responsibility with social responsibility. This book offers a glimpse of the struggle. I found it reasonably sensitive to current issues while challenging healthcare to consider the ethical question from inception to practice.

Professionals who enjoy the fable story telling style of presenting information should be delighted with this book. However, it seems the story telling style selected by Moffic is cumbersome, and makes it difficult to extrapolate information. Weaving consultants into the discussion, while leaving Adam and Evelyn to struggle with the final choices was ironically parallel to how things happen in the real managed care world. Chapter notes are included as commentary on the issues discussed; they are informative, meaningful and often presented a view from inside managed care.

Moffic helps to heighten the importance point that ethics is as much about grappling with issues from multiple points of view as it is about a static code of ethics. This book also contributes to an overall sense that ethics in managed care is a daunting task, with many voices, all of which need to be heard while competing interests are managed in a balance between fiscal and social responsibility.

Wendell J. Montney, Ph.D. is Director of Behavioral Healthcare at Kairos Healthcare, Saginaw, MI. His formal education includes Psychology, Education, and Chemical Dependency. His informal education includes Religion, Theology, Public Health, Managed Care, Current Issues in Medicine and Psychiatry related to Behavioral Healthcare, Organizational Design, Technology, and related Public Policy Issues. Programs at Kairos Healthcare include Intensive Outpatient, Short-term Residential, Intensive Crisis Treatment (Inpatient MH Diversion) and Proactive Development in Partnership wit

Categories: Philosophical, MentalHealth

Keywords: medical ethics, managed mental health, moral aspects