RISULTATI RICERCA

The relationship between health professionals and citizens changes along the time, under the pressure of social modifications. Among other elements, ethics is a relevant factor of change in the relationship. The social consensus on the good practice of medicine has assumed a different outline, according to the value which has assumed a leading function: the patient’s good (ethical principle: beneficence); or the selfdetermination of the subject (ethical principle: justice). The promotion of the empowerment of the citizen is the ultimate model orienting contemporary bioethics.

In many industrialized countries there is a great attention to the reduction of health care costs. Physicians also have become aware of the problem. There are studies that consider the opinion of the physicians about the impact of financial constraints on professional autonomy, but in this article the focus is on managed care mechanisms and the their limits. Melocchi and Tousijn first deal with cost disease. Then they consider some usable tools for health care management. After a short discussion of the well known thesis on the decline of medical professionalism, the authors analyze, with favour, the hypothesis that the best defense of the profession stays in the uncertainty of the physicians’ tasks. We conclude by an appeal to professional associations that they rethink and adapt their professional logic, for some important aspects, to a changing health care system.