BEST: BEST ETHICAL STRATEGIES IN MANAGED CARE

本项目首先观察到，大多数关于管理式医疗的争议，如禁言规则、经济激励、对护理的限制和保密，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式医疗机构变得更有道德。BEST项目基于这样一种理念，即通过向管理式护理计划展示一系列有关这些道德问题的最佳做法，他们可能会采用这些做法。成立了一个由12个管理式护理计划组成的联盟，包括营利性、非营利性、学术性、“蓝调”和基于宗教的计划。研究确定了9个不同的伦理维度：(1)社区利益，(2)弱势群体护理，(3)临终关怀，(4)保密性，(5)组织道德，(6)福利设计和评审，(7)技术评估，(8)财务激励，(9)成员披露和参与。迄今为止，已经完成了四次不同的实地考察，并为若干领域确定了初步的“最佳做法”。2000年2月举行了一次描述最佳实践的会议。

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.