3_9_05_216j_rev - 21A.216J Dilemmas in Bio-Medical Ethics...

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21A.216J Dilemmas in Bio-Medical Ethics 2005/3/9 (W), Week 6, Class 11 Readings Sanchez, Lisa M., and Samuel M. Turner. 2003. “Practicing Psychology in the Era of Managed Care: Implications for Practice and Training.” American Psychologist. 58 (7):116-129 Dickey, Barbara, Sharon-Lise T. Normand, Richard C. Hermann, Susan V. Eisen, et al. 2003. “Guideline recommendations for treatment of schizophrenia: the impact of managed care”. Archives of General Psychiatry. 60 (4): 340-348 Good, Mary-Jo DelVecchio, et al. 1999. “Clinical Realities and Moral Dilemmas: Contrasting Perspectives from Academic Medicine in Kenya, Tanzania, and America.” Daedalus. 128(4): 167-197 Blackboard (Dr Fein—instrumental in medicare and medicaid) Development of Insurance, Medicare and Medicaid 1900 Hospitals utilized more by the poor—“indigents”—who provided “teaching material” for physicians—they were most often non-paying 1929 Dallas, TX, Baylor Univ—when patients did not pay, physicians required payment in advance—Teachers paid $6/year for all medical care and tests 1930s System is generalized and expanded to more employee groups in Texas, then to all—Nationally the model is applied by different state legislatures 1939 “Blue Cross” emblem is applied to this nat’l model by the American Hospital Assoc (AHA) Patients pay a deductible and cover up to 20% of medical costs = indemnity insurance Æ fee for service Didn’t change payment depending on patient risks 1940 World War II/Blue Cross/Blue Shield—armed forces thought they should still receive care b/c they had needs; employers could subscribe through Blue Cross at relatively minimal cost; didn’t fall under tax regulations and to employers benefit to provide these services. BCBS operated like a bank and profited from its subscribers 1950s Other insurance companies saw how profitable it was (John Hancock, MetLife)— for profit insurance companies. As individuals became older, a population hit retirement and had no healthcare whatsoever and some initiatives tried to provide federally funded healthcare—thus emerged Medicare, and Medicaid. July 30 1965 Medicare—over 65 and disabled; Medicaid—for the poor and low- economic class 1970s Healthcare crisis; debt crisis around the world—World Bank; also the oil crisis; global economy is struck; how to limit spending; how to make programs more efficient on a global scale; locally, rising healthcare costs lead to creation of HCO (health care organizations) Definition: Deductible: certain percentage up front © 2005 MIT OCW 1
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“Practicing Psychology in the Era of Managed Care: Implications for Practice and Training.” Primary Question: What is the impact of HCO on mental health care? Are patients receiving the same quality of care under previous system? Pre-paid, no-choice v Fee-for-service Paralleling—the practice of primary care or medicine; psychologists had more time to spend with patients Changing the type of practice that clinicians have to expose or use
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3_9_05_216j_rev - 21A.216J Dilemmas in Bio-Medical Ethics...

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