MANAGED CARE: RATIONING WITHOUT JUSTICE, BUT NOT UNJUSTLY

Three ethical criticisms of managed care are often voiced: (1) by skimming the cream of the patient population, managed care organizations fail to discharge their obligations to improve access, or at least, to not worsen it; (2) managed care organizations engage in rationing, thereby depriving patients of care to which they are entitled; and (3) by pressuring physicians to ration care, managed care organizations interfere with physicians fulfillment of their fi duciary obligations to provide the best care for each patient. This article argues that each of these criticisms is misconceived.