Managed health care and the professional autonomy of medical doctors in South Africa: a normative assessment

Abstract

Spiraling health care costs have posed a threat to access to health care for scheme members, as more has to be done with even less. Managed care programmes were introduced to control the health care costs by reducing medical doctors autonomy. My aim was to ascertain the extent to which the managed care processes impede medical doctors’ autonomy. Principled conditions were identified where the limitation of doctors’ autonomy as a result of managed care could be morally justified which include where implementation would result in a just distribution of resources and a limitation of medically futile treatment. However principled conditions where these managed care tools would not ethically be justified included where they would result in adverse patient outcomes, where they result in a loss of medical doctors morale or where they result in reduced trust in the patient doctor relationship.