Managed Care or Ethical Care: What's in a Name?

Just hearing the term "managed care" is often enough to raise the hairs and pulses of most clinicians. At the 2002 "Behavioral Healthcare & Informatics Tomorrow" conference, Charles G. Ray, M.Ed., who is president and chief executive officer of the National Council for Community Behavioral Health, said that he no longer uses the term. To Mr. Ray and others, the term "managed care" just has too many negative associations with questionable management practices.

What should replace the term? It seems that we need a term that does not ignore the problems managed care was supposed to address and one that will be widely accepted among payers, clinicians, the public, and even politicians.

In the past, James Sabin, M.D., who is editor of the Managed Care column in Psychiatric Services, has advocated for the term "ethical managed care" as an alternative. However, that has not caught on, possibly because it includes the term "managed care" or because it is too long.

Why not drop the word "managed" from Dr. Sabin's recommendation and use "ethical care"? Presumably no one would be offended by this term, and it would not ignore the cost issues influencing managed care. The preamble to the American Psychiatric Association's Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry states, "a physician must recognize responsibility not only to patients, but also to society."

This principle acknowledges the importance of costs but keeps the patient primary. When we use the word "ethical," we recognize the fact that as professionals we have widely accepted principles that can be referred to and used as national standards.

If we can replace the term "managed care," then maybe we can also replace its derivative, "behavioral" health care. Behavioral generally refers only to observable, and possibly measurable, characteristics of a patient. This term seems to fit the focus of managed care—that functioning, not internal suffering, is the most important issue for insurance coverage. Our ethics as health care professionals require us to attempt to alleviate psychological suffering whenever possible. Therefore, when we need to refer to our own specialty, "ethical psychiatric care," or more broadly, "ethical mental health care," would be preferable to "behavioral health care." After all, isn't it our minds that really make us human?