Regulating Managed Care: Theory, Practice, and Future Options

By Stuart H. Altman; Uwe E. Reinhardt et al. | Go to book overview
insurance. In addition, The Lewin Group estimates that a 1 percent increase in employer premiums would lead to an additional four hundred thousand individuals being uninsured, later revised to three hundred thousand being uninsured. Consequently, if these regulations raise the costs of health insurance significantly, a potentially significant number of individuals could be without health insurance, especially employees of small businesses.

References

Atkins, G. L., and Bass, K. ERISA Preemption: The Key to Market Innovation in Health Care. Washington, D.C.: Corporate Health Care Coalition, 1995.

Butler, P. Roadblock to Reform: ERISA Implications for State Health Care Initiatives. Washington, D.C.: National Governors' Association, 1994.

Butler, P. Policy Implications of Recent ERISA Court Decisions. Washington, D.C.: National Governors' Association, 1998.

Butler, P., and Polzer, K. Private-Sector Health Coverage: Variation in Consumer Protections Under ERISA and State Law. Washington, D.C.: George Washington University, 1996.

Copeland, C., and Pierron, W. “Implications of ERISA for Health Plans and the Number of Self-Funded Plans.” EBRI Issue Brief, no. 193. Washington, D.C.: Employee Benefit Research Institute, 1998.

Employee Benefit Research Institute. The Employee Retirement Income Security Act (pamphlet). Washington, D.C.: Author, 1979.

Employee Benefit Research Institute. “ERISA and Health Plans.” EBRI Issue Brief, no. 167. Washington, D.C.: Author, 1995.

Employee Benefit Research Institute.“Regulating Employee Health and Welfare Plans.” EBRI Issue Brief, no. 36. Washington, D.C.: Author, 1984.

Feldman, R., Dowd, B., Leitz, S., and Blewett, L. A. “The Effect of Premiums on the Small Firm's Decision to Offer Health Insurance.” Journal of Human Resources, Fall 1997, pp. 635–658.

Gabel, J. R., Ginsburg, P. B., and Hunt, K. A. “Small Employers and Their

Health Benefits, 1988–1996: An Awkward Adolescence.” Health Affairs, Sept.–Oct. 1997, pp. 103–110.

Liston, P., and Patterson, M. P. “Analysis of the Number of Workers Covered by Self-Insured Health Plans Under the Employee Retirement Income Security Act of 1974 and 1995.” KPMG Peat Marwick, report to the Henry J. Kaiser Foundation, 1996.

Shay, E. F. “Regulation of Employment-Based Health Benefits: The Intersection of State and Federal Law.” In M. J. Field and H. T. Shapiro

-203-

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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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