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Doctor's Dilemma-Advocacy for Whom?

Subjects: Health, Economics
Estimated Time of Completion: 2 days


• To investigate why some doctors feel torn between patients and insurance companies.

• To explore managed care and its implications for patient health care.

• To understand the changes that have occurred within the health insurance field and the impact on the consumer's ability to afford health care insurance.


This activity addresses the following national content standards as established by McREL at

• Knows factors that influence personal selection of health care resources, products, and services

• Knows local, state, federal, and private agencies that protect and/or inform the consumer (e.g. FDA, EPA, OSHA, local prosecutor's office)

• Understands the cost and accessibility of a variety of health-care services(e.g. Health insurance coverage)

ISTE Technology Standards found at

• Routinely and efficiently use online information resources to meet needs for collaboration, research, publications, communications, and productivity.
• Select and apply technology tools for research, information analysis, problem-solving, and decision-making in content learning

McREL Economics Standards found at

• Understands that because citizens, government employees, and elected officials do not always directly bear the costs of their political decisions, sometimes policies have costs that outweigh their benefits for society

• Understands that most federal tax revenue comes from personal income and payroll taxes, and these taxes are used to fund social security payments, the costs of national defense, medical expenditures, and interest payments on the national debt

• Understands that most state and local government revenues come from sales taxes, grants from the federal government, personal income taxes, and property taxes, and are used to fund education, public welfare, road constructions and repair, and public safety

• Understands that government can use subsidies to help correct for insufficient output, use taxes to help correct for excessive output, or can regulate output directly to correct for over- or under-production or consumption of a product

• Understands that governments provide an alternative method to markets for supplying goods and services when it appears that the benefits to society of doing so outweigh the costs to society but that not all individuals will bear the same costs or share the same benefits of these policies

• Understands that incentives exist for political leaders to implement policies (e.g., price controls, barriers to trade) that disperse costs widely over large groups of people and benefit relatively small, politically powerful groups of people.

• Understands that few incentives exist for political leaders to implement policies that entail immediate costs and deferred benefits, even though these types of programs may be more economically effective

Tools Needed

Recommended Web Sites

Pay particular attention to the section # 14 and these four Web sites:

PBS Health Care Crisis

Frontline: Doctor Solomon's Dilemma "Many Doctors Bend Rules to Help Patients"

Frontline: The High Price of Health

• Video: "Healthcare Crisis - Who's at Risk?"
• Computers with Internet access

Procedures and Activities

• Ask students if they had to be admitted to the hospital tonight, who would be in charge of their care? Who would decide their course of treatment? Probably most will answer-the doctor.

• Tell them they'll be seeing a video today in which one doctor and several patients feel differently.

• Further explain that they'll be writing an essay about the statement Dr. Napoli makes about no longer being a patient's advocate and why the doctor might not feel he's responsible for patient care. (Link to quote by Dr. Napoli under the Introduction :

• Try to examine why Dr. Napoli might feel that way.

• Ask if anyone knows the meaning of the term "advocate."

• Tell students to pay particular attention to Dr. Napoli's statements and the individual patients' accounts of problems they've encountered.

• Explain that they are required to use quotes, define examples of problems related to managed care, and use specific references within the video to support their position.

• Ask students to organize their note taking into sections:

• Definition of managed care

• Quotes

• Specific examples of families and doctors problems

• Definition of managed care

• Capitation definition and its role

• View the video "Healthcare Crisis: Who's At Risk?"

• Students have one day to further research the essay (see Web sites listed above) and begin writing. The essay could be completed as a homework assignment.

Assessment .

Student essays may be assessed using the rubric provided.
(Link to this Rubric, in .pdf format)

Doctor's Dilemma: Advocacy for Whom?
1. Explanation of Managed Care 10
2. Explain capitation and its effect 10
3. Quotes: * Patients 10 * Doctors 10
4. Specific examples of problems
* doctors 25 * patients 25
5. Sentence structure, grammar, spellingcorrect 10

Extensions and Adaptations

• A doctor who is part of an insurance network, an insurance agent, a third party administrator and/or an administrator from a managed care company might be excellent choices for class speakers. They could speak individually or as part of a panel using questions the class would prepare in advance.

• Those particular speakers could also be part of an audience as various students read their essays. The speakers would be asked give their reactions from their perspectives.

• Students might also be required to interview at least one person involved in the managed care networking system as part of their essay criteria.


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