Regulating Managed Care: Theory, Practice, and Future Options

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

Chapter Nineteen
The Cost of Regulation
How the Estimates Vary
Allen Dobson and Caroline Steinberg

Much of the impetus for President Clinton's health care reform initiative derived from national attention on costs spiraling out of control and resultant fears about security of coverage. Today, with the strong economy mitigating concerns about loss of coverage, it is not surprising that national attention has turned away from coverage and systemic health care reform toward issues of quality and access.

Although managed care has largely been credited with temporarily bringing health care inflation under control, the processes of managing care are in conflict with a culture used to unlimited freedom of choice among providers and an inviolate physicianpatient relationship. In the quest for lower costs and increased profits, some managed care organizations are perceived as having gone too far in limiting access and utilization. This perception is reinforced by anecdotal reports of the most egregious incidents of denial of care and coverage, which have become a mainstay of news coverage in both the national and the local press. As a result, managed care plans have become a lightning rod for criticism.

In response to highly publicized issues and concerns, both the executive and legislative branches of the federal government have developed proposals, and a majority of states have passed legislation on one or more issues of consumer protection. In March 1997, President Clinton established the President's Advisory Commission on Consumer Protection and Quality in the Health Care

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