The bioethics literature on managed care has devoted
significant attention to a broad range of conflicts that
managed care is perceived to have introduced into the practice
of medicine. In the first part of this paper we discuss
three kinds of conflict of interest: conflicts of economic
incentives, conflicts with patient and physician autonomy,
and conflicts with the fiduciary character of the physician–patient
relationship. We argue that the conflicts are either not
as serious as they are often alleged to be or not unique
to managed care. In part two we argue that managed care
represents a new paradigm for medical care that features
a new concept of management. We discuss three types or
levels of management that managed care highlights, namely,
administrative, clinical, and resource, which together
offer a more sophisticated vantage point from which to
assess patient care. We do not endorse managed care, but
attempt to highlight some of the positive changes brought
by managed care that were difficult to attain under traditional
reimbursement systems.