The rapid rise of managed care in the United States has introduced new complexities into ethical dilemmas in health care by changing the traditional relationships among health plans, payers, providers, and patients. Through twenty case studies that provide snapshots of a wide range of ethical challenges, this book explores the goals, methods, and practices of managed care.

Accompanying each case are questions for consideration and a pair of commentaries by prominent contributors from diverse fields. Through the cases and commentaries, this book clarifies the internal workings of managed care, explains relevant concepts, and offers practical, constructive guidance in addressing the ethical and policy issues.

The cases address a broad spectrum of issues concerning rationing shared resources, financial incentives, quality of care, and responsibilities to patients, vulnerable populations, and the community. Specific topics range from coverage of emergency services through funding medical education to respecting patients' religious beliefs and caring for the seriously mentally ill.

This casebook offers a wealth of insights into critical issues that affect the delivery of managed care in an increasingly competitive market. It will be invaluable for those managing the delivery and financing of health care and for students and practitioners of the health professions and health administration, as well as interested recipients of managed care.

Arthur L. Caplan It is commonly said, especially when the subject is assisted reproduction, that medical technology has out stripped our morality. Yet, as the essays in this volume make clear, that is not an accurate assessment of the situ ation. Medical technology has not overwhelmed our moral ity. It would be more accurate to say that our society has not yet achieved consensus about the complex ethical iss ues that arise when medicine tries to assist those who seek its services in order to reproduce. Nevertheless, there is no shortage of ethical opinion about what we ought to do with respect to the use of surrogate mothers, in vitro fertil ization, embryo transfer, artificial insemination, or fertil ity drugs. Nor is it entirely accurate to describe assisted repro duction as technology. The term "technology" carries with it connotations of machines buzzing and technicians scurrying about trying to control a vast array of equip ment. Yet, most of the methods used to assist reproduc tion that are discussed in this volume do not involve exotic technologies or complicated hardware. It is technique, more than technology, that dominates the field of assisted reproduction. Efforts to help the infertile by means of the manipu lation of human reproductive materials and organs date 1 2 Caplan back at least to Biblical times. Human beings have en gaged in all manner of sexual practices and manipulations in attempts to achieve reproduction when nature has balked at allowing life to begin.

Arthur L. Caplan It is commonly said, especially when the subject is assisted reproduction, that medical technology has out stripped our morality. Yet, as the essays in this volume make clear, that is not an accurate assessment of the situ ation. Medical technology has not overwhelmed our moral ity. It would be more accurate to say that our society has not yet achieved consensus about the complex ethical iss ues that arise when medicine tries to assist those who seek its services in order to reproduce. Nevertheless, there is no shortage of ethical opinion about what we ought to do with respect to the use of surrogate mothers, in vitro fertil ization, embryo transfer, artificial insemination, or fertil ity drugs. Nor is it entirely accurate to describe assisted repro duction as technology. The term "technology" carries with it connotations of machines buzzing and technicians scurrying about trying to control a vast array of equip ment. Yet, most of the methods used to assist reproduc tion that are discussed in this volume do not involve exotic technologies or complicated hardware. It is technique, more than technology, that dominates the field of assisted reproduction. Efforts to help the infertile by means of the manipu lation of human reproductive materials and organs date 1 2 Caplan back at least to Biblical times. Human beings have en gaged in all manner of sexual practices and manipulations in attempts to achieve reproduction when nature has balked at allowing life to begin."