An ethical justification for the Chronic Care Model (CCM)

Liviu Oprea, Annette Braunack-Mayer, Wendy Rogers, Nigel Stocks

    Research output: Contribution to journalArticlepeer-review

    16 Citations (Scopus)


    Background: Chronic diseases are major causes of morbidity and mortality in developed countries. Their effects can be mitigated by high quality evidence-based care, but this is not the norm in most systems. The Chronic Care Model (CCM) is an evidence-based policy response to this practice gap, which uses multiple strategies to promote the quality of chronic care. Objective: To review CCM with an ethical lens. Methods: We reviewed the published empirical and non-empirical articles of CCM to analyse the ethical underpinnings of this model. Results and conclusions: We argue that its principal ethical value lies in the institutional cooperation it builds between the stakeholders involved in health care services. First, we briefly describe CCM and argue that the pathways through which it aims to improve patients' health outcomes are not made explicit. Second, we argue that the potential of CCM to be more beneficent, compared with traditional health care systems, depends on its capacity to promote mutual trust between health care providers and patients. There is no evidence to date that the implementation of CCM enhances mutual trust between health care professionals and patients. Third, we argue that CCM seeks to enhance human agency, allowing increased expression of individual autonomy and increased respect for individuals thereby expanding human freedom and avoiding social discrimination. However, we review the communication patterns that characterize the model of doctor-patient relationship promoted by this model and argue that these communication patterns raise ethical concerns that may prevent the model from reaching its expected outcomes.

    Original languageEnglish
    Pages (from-to)55-64
    Number of pages10
    JournalHealth Expectations
    Issue number1
    Publication statusPublished - Mar 2010


    • Chronic care model
    • Doctor-patient communication
    • Doctor-patient relationship
    • Mutual trust
    • Patient autonomy
    • Social justice


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