Regulating Managed Care: Theory, Practice, and Future Options

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

Foreword

In our pluralistic society, the trends in social policy often swing like a pendulum. They overcome inertia and gain momentum in one direction only to swing back the other way, ultimately settling somewhere near the gravitational center. In issues such as personal health, which touches the lives of all of us, interest in that center is likely to be strong. In 1994, the country rejected a large government role in health care and began to pursue a market-based system. But five years later, after sampling the benefits and detriments of market-based medicine, the pendulum has begun to swing the other way. Legislation to regulate managed care has proliferated at both the state and federal levels of government and is at the top of the congressional agenda as we advance through the last year of the millennium. Policymakers, clinicians, and consumers are struggling to find the right balance between competition and regulation that will result in a high-quality and compassionate health care system, accessible and affordable to all Americans. This volume, with contributions by many of the nation's leading experts in health care policy, provides a comprehensive examination of the issues from a broad range of political perspectives.

In the late 1980s and early 1990s, annual increases in health care inflation were in the double digits, and employers and consumers found health insurance increasingly unaffordable. In response, the Clinton administration attempted to legislate comprehensive health care reform. But the country rejected the government's large role in that plan, and instead pursued marketoriented reforms based on a system of competitive managed care.

Enrollment in managed care organizations grew rapidly during the 1980s, and many analysts have expounded on the potential virtues of managed care: to make the delivery of health care

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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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