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The 21st Congress of CMAAO and 35th CMAAO Council Meeting was held in Wellington, New Zealand on 22 to 24 September 1999, hosted by the New Zealand Medical Association. The meeting was attended by the medical associations of the following countries, namely, Australia, Hong Kong, Indonesia, Japan, Korea, Malaysia, New Zealand, Philippines, Singapore, Taiwan and Thailand. Absent were the medical associations of Bangladesh, India, Nepal and Sri Lanka. Cambodia Medical Association was granted observer status with a view of becoming a member.

The theme for the congress was “Managed Health Care – Ethical Issues”. Four papers were presented for discussion.

“Managed Care and the Future of Health Profession” was presented by Prof John Scott of the University of Auckland. He summed up that managed or integrated care does provide a pathway to solve some of our dilemmas, but each section of society will have to make major concessions. There are huge privacy issues which have yet to be solved, there are enormous ideological battles still to be fought with the bottomline accountants whose myopia seemingly prevents them from encompassing concepts of quality or evolutionary visions of continuing care.

“Professional Ethics and the Managed Care Industry” was presented by Karen Wells. She represented the industry viewpoint. A few concepts such as the principles of equal opportunities and individual freedom, the concept of medical necessity, and the perception of need were brought up for discussion in the context of managed care.

“Meeting Consumer Needs in a Managed Care Environment” was presented by Robyn Stent, New Zealand Health and Disabilities Commissioner. She looked at managed care from the viewpoint of the consumer. Any managed care/integrated care proposal should acknowledge the need to put people at the center of service delivery. Managed care should not be seen only as a tool for cost containment, where services are provided on the basis of financial risk involved.

“The Ethical Dilemma in Managing Access to Medical Services” was presented by Sir B. Elwood, Chief Ombudsman of New Zealand. As he sees it, the ethical dilemma is related to the tension between the accessibility to and the affordability of health care and can be quite starkly described.

a) Can we hold onto an assumption that medical ethics requires the provision of anything other than the higher quality of care in every case, regardless of cost or,

b) Must we accept that something less than the higher quality of care can be ethically justifiable because resources are scarce?

“Managed Care – Legal Conservation” by Dr David Collins, a barrister. In many instances those promoting changes appear to be unaware of legal implications raised by various managed care models. Some of the legal issues associated with managed care are: 1) potential liability of managed care organisation for inadequate patient care, 2) potential liability by health care professionals for inadequate patient care, 3) employment implications for health care professionals who contract with MCO, (4) patient choice, and (5) privacy. Structuring our health services to suit an economic theory is fraught with legal difficulties which too often only emerge when the systems are established and firmly in place.

The papers presented were of a very high standard. Copies of the full text are available from the SMA Secretariat.

On the social side of the congress, the Governor General of New Zealand, Sir Michael Hardie Boys hosted a reception at the Government House on the first night. The associate Minister for Health, Hon Tauriki Delaware, hosted a reception at Parliament House on the second night.