BEST: BEST ETHICAL STRATEGIES IN MANAGED CARE

这个项目首先观察到，关于管理式医疗的大多数争议，如封口令、财务激励、医疗限制和保密，都可以被视为道德问题。批评、病人权利法案或其他方法不太可能让管理型医疗组织变得更有道德。最好的项目是基于这样一个想法，即通过向管理型医疗计划展示关于这些道德问题的最佳实践列表，他们可能会采用这些做法。建立了一个由12个管理保健计划组成的联盟，包括营利性、非营利性、学术、“布鲁斯”和基于宗教的计划。确定了九个不同的道德层面：(1)社区福利，(2)照顾弱势群体，(3)临终关怀，(4)保密，(5)组织道德，(6)福利设计和裁决，(7)技术评估，(8)财政奖励，以及(9)成员披露和参与。到目前为止，已经完成了四次不同的实地考察，并确定了若干领域的初步“最佳做法”。2000年2月举行了一次描述最佳做法的会议。

This project begins with the observation that most of the controversy about managed care, such as gag rules, financial incentives, limits on care, and confidentiality, can be viewed as ethics problems. It is unlikely that criticism, a patients bill of rights, or other approaches will get managed care organizations to be more ethical. The BEST project is based on the idea that by showing managed care plans a list of best practices regarding these ethical issues, they might adopt them. A consortium of 12 managed care plans was established, including for-profit, not-for-profit, academic, "Blues," and religious-based plans. Nine different ethical dimensions were identified: (1) community benefit, (2) care of vulnerable populations, (3) end-of-life care, (4) confidentiality, (5) organization ethics, (6) benefit design and adjudication, (7) technology assessment, (8) financial incentives, and (9) member disclosure and participation. So far, four different site visits have been completed and preliminary "best practices" have been identified for a number of areas. A conference delineating best practices was held in February 2000.