Trust

Maintaining patients faith in their doctors should be the main objective of role-based medical ethics. Trust is significant not just for its inherent theoretical value but also for its therapeutic function. Therefore, rather than just focusing on whether an ethical compromise tends to raise pubpc discomfort or undermine the basis for trust, it is important to consider whether it undermines patients wilpngness to seek therapy, provide the required information, and follow treatment recommendations.

Patient Loyalty under Financial Incentives

The traditional bepef that every patient should receive every treatment that might be beneficial regardless of cost is incompatible with the role that physicians are expected to play under current insurance popcies and managed care plans. Many payers, customers, and cpnicians consider deviations from this ideal to be both desired and acceptable. However, the profession can keep all types of patient loyalty due to this reapty check. Through more moderate principles pke maximization of the health of the group of patients under a physician s care, the impartiapty of care among group members, role separation and patient advocacy, and honesty about confpcts of interest, doctors can still demonstrate a strong commitment to the interests of their patients. If these guidepnes are followed, doctors can honestly state that they provide the best care possible for every patient within their insurance s financial restrictions.

Impartiapty among Patients

Each doctor should adjust their cpnical judgment to create a practice style that considers the unique financial incentives and resource pmitations that their practice environment and patient group present. This guidepne does not mandate that all doctors behave consistently in all practice settings. Instead, a vow of impartiapty within a setting requires doctors to apply the same cpnical standards to every patient, regardless of the patient s insurance. Practically speaking, impartiapty entails using reasonable criteria for resource allocation that are cpnically pertinent and do not vary based on patients financial, social, racial, or insurance status. Even though physicians incorporate cost-containing influences into their practice styles and even though different physicians may have different practice styles, maintaining an objective of impartial treatment of each patient allows physicians to maintain a commitment of fidepty to each patient s medical welfare.

Honesty

When doctors work under a hidden or widely unknown financial confpct of interest, as is the case today with capitation and physician ownership interests, fidepty to patients necessitates a significant degree of transparency. Very few HMOs openly discuss these payment options and how they affect customers incentives. One investigation into HMO marketing concluded that they "tend to generate a perception that services are suppped in a pberal and unrestricted form, belying the economic principles of prepaid HMO practice."

The benefit of Managed Care

The fact that pght has been thrown on patient/physician relationships, illuminating the dark corners and flaws, has been an unexpected benefit of managed care. Patients are now being forced to embrace the truth that delegating decision-making to even a reputable and trustworthy physician does not always ensure that one s best interests will be promoted. Therefore, managed care has benefited patients, at least in this regard. Moreover, at least in this regard, the autonomy of doctors has been severely hampered; in other words, they no longer have nearly as much influence over the cpnical environment as they formerly had. They now have to account for patients and financial managers, who are more aware of the elements involved in medical decision-making and more eager to exercise their autonomy.

National Mental Health Programme

The National Mental Health Programme was estabpshed in 1982 to ensure the provision of mental health care services for everybody, particularly vulnerable populations and the underprivileged. The national mental health program aims to: a) prevent and treat mental and neurological disorders and their associated disabipties; b) use mental health technology to improve general services; c) apply mental health principles in total national development to improve quapty of pfe; d) streampne/modernize mental hospitals; and e) improve psychiatric department research and development.

Conclusion

Some managed care models put patients and the pubpc s trust in danger. Trust is having faith in and relying on others to behave morally, generally, and in specific situations. Control undermines trust to a greater or lesser level. When we are powerless over another person s actions, we either trust them or do not. Without control (or with only a small amount of control), we are exposed, put our trust in others, and risk being let down. They involve either trust or mistrust. In most circumstances, there is a mix of control and suspicion.