Ethical Considerations in the Changing Environment

Managed care refers to a variety of integrated financing and delivery procedures for controlling, coordinating, and monitoring the delivery of health care to limit overuse of services and over-charging by professionals and to ensure that health care planning is consistent with MCO standards which may, or may not, coincide with professional standards (Barakat, 2000; Gibelman, 2001/2002). Following enactment, in 1965, of Medicare and Medicaid, utilization rates for health services exploded (Mitchell, 1998). Included in this escalating total was an increasing proportion of costs for mental health and social services. Older adults generally require more medical care and services than do younger people; with Medicare coverage, consumers had access to more of the services they needed with much of the cost covered by government. The poor have traditionally been under-utilizers of health and mental health care services, primarily because these services were unaffordable. With Medicaid, barriers to access were removed. Significantly, the population which benefitted from government health and mental health programs was to later feel the brunt of cost management efforts (Gibelman, 2001/2002).