MANAGED CARE
Managed Care is a medical distribution scheme planned to manage charges, application, and value. Medicaid managed care delivery for the distribution of Medicaid well-being assistances and extra amenities through contracted engagements among state Medicaid organizations and managed care establishments (MCOs) that agree to a set per associate per month (tax) disbursement for these amenities. Through contracting with several categories of Managed Care Organizations to deliver Medicaid platform health care amenities to their recipients, countries can decrease Medicaid package prices and better manage employment of health facilities. Enhancement in health organization presentation, medical excellence, and results are important goals of managed care (Gervais, 1999).
Managed health care is mainly concerned with the cost of health care. The supporters of managed care see cost as the biggest problem in health care sector, rather than obtain-ability, excellence, and access. Moral complications emerge in part since dealing with costs through managed cost organizations that bound and restrain physician decisions is not compatible with the traditional formation of doctors as supporters for their patients’ medical requirements.
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Doctors’ decisions about proper upkeep for their patients clearly have a major financial effect, after all; doctors are answerable for seventy-five percent of all health care expenses. For the physicians to control these expenditures the managed costs organizations presume physicians to temper their medical endorsements both because they know the resources in the health care sectors have restrictions within the MCOs and sometimes because they have financial motivations to work under managed care. Case studies have given evidence of the ethical dilemmas of managed care to be the impairment of the patient-physician connection, and especially patient confidence, through MCOs monetary incentives for the provider to manage care (Gervais, 1999).
The case study by Haavi Morreim, “Balancing Act: The New Medical Ethics of Medicine’s New Economics”. It talks about the positions the patients and the physicians are put in when using managed care. The case focuses on the ethical dilemma doctors have to deal with daily especially when there are incentives for them to limit procedures or provide unnecessary procedures. The two affect patients because in the case where the physician has to define procedures the patient might suffer more because he/she might miss crucial discoveries regarding the ailments because some procedures were not done and there is no one to recommend them. This example means that the patient might miss getting the right treatment leading to future complications or even death. In the case where the physicians provide unnecessary procedures the patient has the option of seeking a second opinion on the mode of treatment, this might not be detrimental as the first example (Gervais, 1999). This case study also indicates that managed care takes away more than just the cost of health care; it reduces the quality and puts physicians in an awkward position in regards to their relationships with their patients.
However, even with the provision of incentives physicians have to operate under the code of ethics provide under the medical profession. The medical practice is guided by both laws and ethics; this process means that the care providers have to adhere to the rules and principles when making decisions even in managed care. The physicians need to consider the AAMFT Code of Integrities and relevant standards and guidelines in their profession. In cases where the AAMFT Code of Ethics recommends a standard greater than that compulsory by by-laws, physicians must follow the AAMFT Code of Ethics. Health care providers obey with the directives of regulations but may identify their pledge to the AAMFT Code of Ethics and undertake measures to resolve ethical issues in an amicable manner. The AAMFT provides permissible directives for reporting of suspected unethical behavior.
The use of technology in counseling
Marshall McLuhan once stated that the “medium is the message,” however that phrase did not mean much in the past, but presently the technological innovations are shaping the mode in which mental health professionals interact, and treat their patients. The present generation has lived with technology since birth; therefore it is part of their everyday life and it rapidly becoming a part of how they seek support and other medical services. For this reason, doctors are forced to use technology to expand their business reach. A study was done to answer the question of how counselors can ethically navigate the unfamiliar scenery of therapy the Digital Age (Anthony, Nagel, and Goss, 2010).
The digital world is well familiar for those of the digital age plus the digital immigrant who are not of the digital world, yet they become familiar with the evolving technology. Social media is one form of technology that mental health practitioners are slowly adapting to use in their practice. This technological Avenue is giving counselors an opportunity to explore and offer services that are more excellent and extensive techniques than in the past. Technology lifts constricting conditions through virtue of topographical position, mobility restrictions, time zone, and the public humiliation of only visiting the therapist’s place of work. All these are overawed by innovative and better prospects for secrecy, easy admittance, and larger suppleness.
Technology has many advantages for both the clients and the counselors, however, there other ethical issues that are harder to uphold because it invades the counseling space which is supposed to be a haven for the users. Though most of the threats present themselves in unique ways, they are based on the same problems therapists have been facing in the past. These are problems on boundaries, with the consequence issues of privacy and double or compound relations plus the connected subject of exposé. This issue focuses on how much information a counselor and a patient should disclose to each other and what way to acquire the information. Social media creates a threat to maintaining boundaries between clients and therapists, in past people had the option of keeping their personal data away from their professional lives. However these days it only takes a few clicks for a person to acquire information regarding any professional especially if they too are in social media (Anthony, Nagel, & Goss, 2010).
A case study done on social media shows that for every ten respondents eight of them have sought information regarding counseling plus they have requested information regarding a particular health practitioner.
Counselors are mandated by laws, morals and ethics not to harm their patients, therefore creating boundaries ensures they fulfill their responsibilities. People seeking counseling expect that their information is kept confidential plus the information they share cannot be disclosed to anyone without their consent. When counselors do not maintain their boundaries they not only harm their clients but they also damage the reputation of the counseling and psychology disciplines. The clients have rights by law for their well-being to be protected by those given the mandate of handling their cases. If counselors fail to safeguard the rights of their clients, then the public loses faith in their expertise and professionalism. The therapists operate under the ACA code of ethics; this requires them to be ethical in their use of social media for their clients. This code of ethics offers current or extended recommendations for averting the burdens of personal therapist principles, distance therapy, privacy, dual interactions, multiculturalism and miscellany, the usage of technology, record protection, analysis, and the choice of intermediations (Anthony, Nagel, and Goss, 2010).
The case involving the Julea Ward vs. the Board of Regents of Eastern Michigan University shed light on the use of the ACA code of ethics in resolving the ethical dilemma that counselors are faced with regarding performing their duties and the use of technology. The example also restated that equivalent moralities and social fairness continue being the principal supports of the therapy business.
Cross- cultural counseling
Counseling is an interactive process characterized by a unique relationship between counselor and client that leads to a particular change in one or more areas (Trickett, Sept. 9, 2003). Multicultural counseling requires the recognition of the importance of racial/ethnic group membership on the socialization of the client. The importance of and the uniqueness of the individual; the presence of and place of values in the counseling process; and the unique nature of learning styles, vocational goals, and life purposes of clients, within the context of principles of democratic social justice (Sue, Gallardo, and Neville, 2013).
The conjectural and certified fundamentals of multiethnic therapy have advanced; a healthy development has been the growth of ethical values to help control the exercise of multicultural therapy. A case study was done find out the ethical standards concerning cross-cultural counseling in the education sector, research, study, valuation, and practice. Right treatment and research of participants in therapy are the other aspects of discussed in the survey so as to bring attention to the subjects connected to the ethics in cross-cultural counseling. The ACA has specific regulations on the ethical conduct of counselors regarding their practices; they are expected to avoid prejudice, respect diversity, plus exhibit cultural thoughtfulness dealing with clients directly. They should be mindful of their customer's education, testing, research, the computer applications they use in their practices plus public relations and the employer-employee relations (ACA, 1995). The ACA requires counselors to demonstrate a guarantee to gain information, cognizance, and abilities associated with helping all diverse types of clients. Investigators show the necessity mold specialist in becoming more competent in handling ethical dilemmas, especially those involving cross-cultural subjects in the therapy sector. Counselors often deal with complex ethical dilemmas; however, the complexity is heightened when dealing with clients from diverse cultures and opinions. The therapists have to develop ethical decisions making skills to help deal with the convergence of current information regarding multiethnic therapy theory and moral perceptive (Sue, Gallardo, and Neville, 2013).
Therapists have an obligation to integrate culture into their everyday decision making, to help the deal with issues affecting clients who come cross-cultural backgrounds. This process helps therapists ensure their offices are open ad safe for people of all cultures to seek help. It reduces stigma and prejudice people face because of their race, religion, tribe or ethnicity. This example helps create a safe environment for them to lay out their problems without fear of being turned away or mistreated.
Therapists are not supposed to show their opinions regarding any cultures at work; a counselor should not be biased in dealing with particular cultures according to the ACA code of ethics. Even if a therapist has any misgivings regarding people of a particular gender, religion, race, or ethnicity they should not show it at work. They are guided by principles that ensure they do not discriminate or disrespect people by the above features. The laws regarding human rights provide avenues for people to report medical practitioners that violate human rights or use their offices to promote social injustices (Sue, Gallardo, and Neville, 2013).
Even though therapists are health specialists considerably like doctors and nurses, we trust on the formation of understanding in the therapy association, which is more similar to spiritual admission than a physical examination. In this compound characteristic of the therapy relationship, merely the declaration of generally held principles and standards can offer a palpable alleyway to a proper exercise. The ethical dilemma is present especially when a therapist is confronted with clients whose values and beliefs that are different from their own. In such cases the counselor ought to focus on the education, they got from their training regarding the fundaments of counseling which require them to put their opinions aside and give their advice from a professional point of view instead of basing their information on personal perspective (Sue, Gallardo, and Neville, 2013).
Religion and spirituality in counseling
Councilors are guided by the ACA code of ethics regarding the effect of imposing the religious beliefs on their clients. The counselors use the original alignment to help them deal with issues regarding spiritual and religious perspectives provided by their customers; these arrangements are employed in the training process of counselors to help them contain themselves even if they come across clients with beliefs that differ from their own. There has been an instruction of new legislative trends that help counselors reduce the referral cases because there were ethical dilemmas in the client-counselor perception of values.
There have been many cases where therapists are faced with religious difficulties in dealing with their clients, for instance, a Christian therapist receives a client who is gay, their religion condemns such people because of their sexual preferences, but in this case, the counselor must not impose his values on the customer. They must receive the client, keep their information and discussion private because they operate under certain laws, and code of ethics in their practice. The code of ethics is the key to solving ethical dilemmas that counselors face in their practice (Fehrenbacher, 1969).
The best way to approach religious and spiritual ethical dilemmas is to take on a psycho-spiritual attitude that is focused on the identification of mutual ground or common subjects which are likely to form the basis of client-counselor relationship. This kind of approach gives the counselor self-awareness, on the issues that clients might come up with about religion and spirituality. In the counseling training, there are simple therapy programs which have a vested importance in assimilating a spiritual or divine assessment in therapist teaching against non-spiritual descriptions that lean towards viewing this characteristic of the client merely as a constituent of patient diversity. The disadvantage of this training is that it disregards any information the counselor might want to refer to when giving opinions from a holistic point of view (Fehrenbacher, 1969). This process becomes a problem because an advisor is given the option of providing information to a client through suppressing and squashing all information therefore for some therapists it might not be satisfactory to them when dealing with customers.
Researchers like Kenneth Pargament provide views regarding radical alignment; Kenneth said that spiritual and religious beliefs are a priceless part of our everyday lives and they give meaning to livelihood, religious and spiritual growth and they form our identity as individuals and as components of a larger society. To avoid dilemmas while working counselors must recognize the universal themes that unite all persons regardless of their religion, spiritual orientation, or faith offers therapists with treasured understanding into the internal mechanisms of the client without the therapist comprising their beliefs (Fehrenbacher, 1969).
Even though therapists are health specialists considerably like doctors and nurses, we trust on the formation of understanding in the therapy association, which is more similar to spiritual admission than a physical examination. In this compound characteristic of the therapy relationship, merely the declaration of generally held principles and standards can offer a palpable alleyway to a good exercise. The ethical dilemma is present especially when a therapist is confronted with clients whose values and beliefs that are different from their own. In such cases the counselor ought to focus on the education, they got from their training regarding the fundaments of therapy which require them to put their opinions aside and give their advice from a professional point of view instead of basing their information on personal perspective. Ethical dilemmas affect how physicians or counselors offer their services; however, there rules, regulations, and code of ethics that help them deal with issues that go beyond their personal beliefs.
References
Anthony, K., Nagel, D. A. M., & Goss, S. (2010). The use of technology in mental health: Applications, ethics, and practice. Springfield, Ill: Charles C. Thomas Publishers.
Fehrenbacher, D. E. (1969). The era of expansion: 1800 - 1848. New York [u.a.: Wiley
Gervais, K. G. (1999). Ethical challenges in managed care: A casebook. Washington, DC: Georgetown Univ. Press.
In Sue, D. W., In Gallardo, M. E., & In Neville, H. A. (2013). Case studies in multicultural counseling and therapy.
