Regulating Managed Care: Theory, Practice, and Future Options

By Stuart H. Altman; Uwe E. Reinhardt et al. | Go to book overview

information on this and all other health plans doing business in the state. Such a farmers market would retrieve much of that information itself, directly from enrolled consumers, and would have the power to audit self-reported data. And its information would be available in multiple media, including on the Internet.


Notes
1
Huber, R. L. “Let the Market Remedy What Ails Health Care.” The Wall Street Journal, July 13, 1998, p. A14. Huber is chairman and CEO of Aetna, Inc., a major managed-care company.
2
Ellwood, P. M., Enthoven, A. C., and Etheredge, L. “The Jackson Hole Initiatives for a Twenty-First Century American Health Care System.” Health Economics, 1992, 1, 149–168.
3
Krueger, A. B., and Reinhardt, U. E. “The Economics of Employers Versus Individual Markets.” Health Affairs, 1994, 13 (2), 34–53.
4
United States Congress, Congressional Budget Office. Economic Implications of Rising Health Care Costs. Washington, D.C.: U.S. Government Printing Office, 1992.
5
For a defense of that proposition, see Reinhardt, U. E. “EmployerB ased Health Insurance: R.I.P.” In S. A. Altman, U. E. Reinhardt, and A. S. Shields (eds.), The Future of the U.S. Healthcare System: Who Will Care for the Poor and the Uninsured? Chicago: Health Administration Press, 1997.
6
Berenson, R. A. “A Physician's View of Managed Care.” Health Affairs, 1991, 10 (4), 106–119.
7
Huber, R. L. “Market Remedy, ” p. A14.
8
Miller, R. H., and Luft, H. S. “Managed Care Performance: Is Quality of Care Better or Worse?” Health Affairs, 1997, 16 (5), 7–27.
9
Newcomer, L. N. “Perspective: Physician Health Thyself.” Health Affairs, 1998, 17 (4), 32–35.
10
Millenson, M. L. Medical Excellence: Doctors and Accountability in the Information Age. Chicago: University of Chicago Press, 1997.
11
Millenson, M. L. “Miracles and Wonder: The AMA Embraces Quality Measurement.” Health Affairs, 1997, 16 (3).
12
Reinhardt, U. E. “Spending More Through Cost Control: Our Obsessive Quest to Gut the Hospital.” Health Affairs, 1996, 15 (2), 145–154.
13
Eddy, D. M. Clinical Decision Making: From Theory to Practice. Boston: Jones & Bartlett, 1996. See especially Chapter 27, “Rationing Resources While Improving Quality, ” pp. 279–296.

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Regulating Managed Care: Theory, Practice, and Future Options
Table of contents

Table of contents

  • Title Page *
  • Contents vii
  • Foreword ix
  • Acknowledgments xiii
  • The Editors xv
  • The Contributors xvii
  • Introduction - The Philosophy of Regulation xxi
  • Notes xxxii
  • Regulating Managed Care xxxiv
  • Section I - The Role of Regulation in a Market-Oriented Health Care System 1
  • Chapter One - An Overview 5
  • Notes 27
  • Chapter Two - The Current Status of State and Federal Regulation 29
  • References 51
  • Chapter Three - Why Should Managed Care Be Regulated? 53
  • Chapter Four - Macro-Versus Microregulation 75
  • Reference 85
  • Section II - Regulatory Issues 87
  • Chapter Five - Consumer Choice Under “private Health Care Regulation” 91
  • Notes 114
  • Chapter Six - A Model for Health Care Consumers 117
  • Notes 133
  • Reference 133
  • Chapter Seven - Ensuring Equal Access to Care 135
  • Notes 143
  • Chapter Eight - Regulating Quality and Clinical Practice 145
  • Chapter Nine - The Scope of Managed Care Liability 160
  • Notes 185
  • Reference 186
  • Chapter Ten - Erisa and the Regulation of Group Health Plans 189
  • Notes 200
  • References 203
  • Section III - Perspectives on Regulation 205
  • Chapter Eleven - Understanding the Managed Care Backlash 209
  • Notes 224
  • Chapter Twelve - Core Principles for Regulating Health Care Quality 229
  • Notes 237
  • Chapter Thirteen - Balancing Market Forces and Regulation 239
  • Notes 262
  • Chapter Fourteen - Regulation from a Consumer's Perspective 263
  • Notes 274
  • Chapter Fifteen - Regulation from an Insurance Industry Perspective 276
  • Notes 281
  • Chapter Sixteen - Regulation Misses the Big Issue—the Uninsured 282
  • Notes 297
  • Section IV - Managed Care Regulation in Practice 299
  • Chapter Seventeen - A Practical Approach 301
  • Chapter Eighteen - California's Struggle with Regulation 312
  • Notes 329
  • Chapter Nineteen - How the Estimates Vary 331
  • Notes 343
  • Index 345
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