Patient Advocacy in the 1990s

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Abstract
In this decade of cost containment in medicine,1,2 many of us have encountered insurance carriers that denied coverage for certain medically indicated procedures or treatments. Managed care has also led to centralized planning and reimbursement for expensive treatments such as organ transplantation, with some insurers restricting the choice of institution on a contractual basis. Those of us in academic medicine have had less experience with these phenomena than other physicians, but that fact is rapidly changing.3 A recent experience at our institution highlights the ethical conflicts that can arise during the referral of a patient in a managed-care system. . . .