Newspaper article The Christian Science Monitor

New Referee on Health Care in Tackling Managed Care, Congress Will Try to Keep Quality High and Costs from Rising

Newspaper article The Christian Science Monitor

New Referee on Health Care in Tackling Managed Care, Congress Will Try to Keep Quality High and Costs from Rising

Article excerpt

Washington is gearing up for a battle royal next year over how much the federal government should regulate "managed care" - health-maintenance organizations and their increasingly popular alternative, preferred-provider organizations.

Congress already has before it dozens of bills to increase federal regulation of managed care. President Clinton entered the fray last week with his proposal for a patient "bill of rights."

HMOs and PPOs have changed the face of health care in America by corralling runaway medical costs. But they've done so by limiting how much and what kind of care patients can receive. This has opened managed-care systems to sharp public criticism. Doctors and others say it interferes with treatment decisions. Patients say they have been denied what they believe was crucial treatment when insurance providers refused to pay. Now Congress is taking on the role of referee - trying to ensure quality care while keeping costs from rising. The plans for achieving this tough balance are legion. The guarantees in Mr. Clinton's "bill of rights" include the right to accurate information about health plans and facilities; "sufficient" choice of providers; paid emergency-room visits; confidentiality of records; and the ability to appeal treatment denials to an outside board. Among the most comprehensive congressional proposals is a bill sponsored by Sen. Alfonse D'Amato (R) of New York and Rep. Charlie Norwood (R) of Georgia. That measure would require paid emergency care, 24-hour access to emergency care, and an appeal process. Another bill, sponsored by Sen. Edward Kennedy (D) of Massachusetts and Rep. John Dingell (D) of Michigan, contains similar provisions, but would also allow a woman to designate an obstetrician/gynecologist as her primary caregiver and require plans to refer patients to a specialist when necessary. Both bills would amend federal law to allow individuals to sue health plans for medical malpractice under state laws. The proposals are the latest in a series of moves by the White House and its allies on Capitol Hill to achieve at least part of what the president failed to get in his all-encompassing 1994 proposal to reform health care. …

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