Negotiating HIV-related ethical dilemmas.
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As the author of Tribal Warfare in Organizations, I have spent my career refereeing conflicts among the tribes in organizations. Health care has more tribal battles than most other work settings. Although some people swear that health care attracts a higher percentage of cantankerous personalities, this is not true. Complexity breeds tribal tensions, and health care is a very complex environment. There are more professions, more highly complex services, and fewer resources.
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Getting the money your practice earns from providing managed care requires you to take the initiative. Know the details of each contract, know your practice's strengths, have a fair fee schedule, apply your leverage and be willing to walk away if a poor deal is all that's forthcoming.
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In substance abuse managed care, the number of treatment sessions that a provider can deliver is constrained by the policies and procedures of the specialized managed care organizations (MCOs) that typically administer the substance abuse portions of healthcare plans. Managed care organizations commonly are alleged to control treatment providers through rules, but they also might rely on a particular patterned authorization of discretion, whereby they determine when and how frequently to respond to providers' appeals of rule-based decisions. The current paper uses data from a national random sample of managed care contracts between MCOs and substance abuse providers to test the hypotheses that (1) managed care organizations' "logics" about the types of provider discretion to allow affect the rate to which they concede to appeals, and (2) the rate of conceding to appeals, in turn, affects the providers' duration of substance abuse treatment. Results from generalized linear estimation models support the hypotheses and suggest that many MCOs pattern discretion to balance strict rules with concern about the quality or cost of care. The results more generally suggest that MCOs use discretion in planned ways, and thus that the patterns of control are more complex and sophisticated than commonly described in the literatures on managed care, transaction cost economics, or other perspectives.
This article presents findings from a qualitative study on the perspectives of sexually active men and women about the risks of unwanted pregnancy and HIV/AIDS. The study found that there is a high level of awareness of the risk of unwanted pregnancy and HIV/AIDS. Knowledge of condoms as a method of preventing pregnancy and HIV/AIDS is also relatively good. However, there are many real and perceived barriers to condom use especially in stable sexual relationships. In stable long-term relationships, resistance to condom use was found to be strongly related to its association with STIs (including HIV/AIDS). Men and women do not see the need for condoms in stable, ongoing sexual relationships if a more effective method is used for pregnancy prevention. Condom use in such relationships may be seen as a clear sign of infidelity. These attitudes represent a major obstacle to the use of condoms as a dual method of protection.
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