Ethical Conflicts: System & Interest of Others
Marietta Miller-Jones, MSEd
Unit 5: Ethical Conflicts
To discuss what is meant by “system culture”
To discuss how system culture impact ethical decision-making?
To review examples of ethical conflict when working in a managed- care environment
To review examples of ethical conflict when working with 3rd-party payees
What does the term “System Culture” mean?
The Ethical Culture of Social Systems consists of:
An organization that develops their own values or standards to guide decision making within the culture of that organization
An organization that values their own system’s view of what’s important as it relates to goals, activities, relationship, and feelings
Systems of Culture Consists of:
A pattern of basic assumptions that is taught to members in a new setting, culture, environment, etc.
An invented or developed way a group should adopt to rules, regulations, policies An integration, adaption, acceptance, & expectation to comply w/the organization’s internal/external system because the company’s mottos is: “it works for us” thus, it’s valid to us—there’s no need to change; this can also lead to “group think” i.e., going along to get along
Systems of Culture Cont’d…
A company’s perceived correct way to think and feel in relation to internal/external problems
An organization develops & maintains its system’s culture which is not to be questioned or challenged i.e., “this is the way we’ve always done it”; “if-it-ain’t-broke-don’t-fix-it” mentality
The System’s Goals vs. The Helper’s Values
When making ethical decisions w/in an organization’s system (ex: Kaiser, BC/BS), a helper must be mindful of their values when making a “good-faith” effort to treat their client’s needs
Helpers practicing counseling w/in an organization who uses 3rd-party managed- care systems to fund their client’s services, should be aware of the subtle influence their organization may have when setting goals and/or making decisions for the needs of clients (ex: the services may be limited to a certain number of sessions), this means you have a limited amount of time to spend counseling your client (i.e., 4 sessions for 45 mins. each)
The System’s Goals-The Helper’s Values Cont’d …
Thus, the helper who accepts a position with an organization will have to sign a contract agreeing (and embracing) the values & standards of practice within that organization!
Who is the Client?
According to ALL professional organization guidelines, the needs of the client are the primary concern thus, thus this may conflict with the institution/organization’s systems of culture
However, helpers must be accountable & responsive to both the organization’s system AND to the clients, they service within that system; this is what is meant by “Multiple Masters”
Manage Care System & The Client
What is a manage care system?
A cost-effective systems designed for Health Maintenance Organization (HMO) are to provide equal or better care to patients
It is designed to be a cost-saving for clients to pay for their mental health counseling through their employer’s managed care system i.e. Blue Cross/Blue Shield, Kaiser Permanente, Aetna, etc.
A professional counselor may work with clients who pay for their sessions through an HMO, but may be limited to the # of sessions their client may need
A managed care organization challenges a professional to provide ethical treatment according to the needs of the client
Financial Incentives in Managed Care Systems
Financial incentives benefit HMO’s & the Practitioner BUT:
Denies and limits the clients’ access to long-term therapy
Narrows the clients’ choice of a therapist
Disrupts the continuity of care
Sometimes relies on less-qualified practitioners to service clients
Ethical Issues in Managed Care
Confidentiality – does restrict some access to client’s records which threatens the fundamental concept of “confidentiality, but some access may be required on an as-needed-basis ex: a client using his/her Employee Assistance Plan (EAP)
Informed consent – ethical practitioners will need to discuss w/the clients what will be covered through their insurance which may affect the type of treatment available to them, # of sessions, the amount of time per session, etc.
Client’s limited by their insurance may be undertreated, underdiagnosed, or receive no follow-up care
Abandonment – it is unethical for a helper to abandoned a client! it is imperative that helpers understand the ethical standards of practice within the manage care’s system & the guidelines of their professional organization
Group Case Study Practice
You are treating clients insured under their company’s HMO; however, you billed the HMO and received a letter stating that “Due to COVID-19 reimbursements will be delayed because state funding is being allocated to hospitals providing mental health counseling to Covid patients at this time” however, you’re treating two clients who are depressed and grieving because they’ve lost family member(s) due to the virus…
Would you continue treating your clients not knowing when you will be paid for your services with
the same quality of care? Yes or No
2) Would you limit the amount of time you would normally spend with your clients to take on more
clients who can pay out of pocket? Yes or No