Managed Care and Emergency Medical Ethics

Approved October 2006
Reaffirmed by the ACEP Board of Directors October 2006
Reaffirmed by the ACEP Board of Directors October 2000
Originally approved by the ACEP Board of Directors September 1996 

Quality health care depends on the integrity of and trust in the physician-patient relationship. If third-party cost concerns supersede patient interests, trust will be eroded. To uphold patient trust and to provide moral guidance for emergency physicians practicing in an increasingly corporate health care environment, the American College of Emergency Physicians endorses the following.

• The ethical obligations of emergency physicians do not change when practicing in a managed care or any other environment. The physician's primary responsibility remains with the patient.
• When the economic interests of physicians, hospitals, purchasers of health services or managed care organizations are in conflict with patient welfare, the highest priority is patient welfare.
• Because the financial resources of our society are finite, emergency physicians have a responsibility to practice medicine in a cost-conscious manner. Regardless of the payment structure, the emergency physician should not provide care without reasonable expectation of patient benefit.
• Emergency physicians should follow only managed care policies and utilization management guidelines that are ethical, compassionate, and consistent with professionally accepted standards of emergency care.
• Emergency physicians endorse patient autonomy and choice. Patient autonomy is best respected when managed care organizations' policies and procedures are made explicit in advance to all enrollees and participating physicians. An emergency physician must be allowed to discuss health care plan limitations with a patient when it is in the patient's best medical interest to do so.