Regulating Managed Care: Theory, Practice, and Future Options

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

performs today, care might not be available or paid for when they are very sick.

Some experts believe that providing report-card ratings of health plans will enable consumers to make the best decisions for their families and negate the need for government regulation. However, report cards will be seen as providing little protection by the large portion of the population who have no experience using this type of rating. As a result, if concerns arise about the threatening behavior of individual health plans, a share of the public is likely to support some degree of regulation rather than depending on report-card ratings as a way of avoiding the consequences of plan decisions. For example, for airline safety, although safety reports and consumer complaints are provided by airlines as a matter of public record, experience suggests that these reports have not quelled the public's desire for some level of government safety regulation. Still, report cards could play a role in the decision making of employers who want to make the best choice of health plans for their employees. This in turn could have an influence on the quality of plans available in the marketplace.

Public concerns about the need for increased regulation of managed care are likely to be with us for the long term. Experience in other industries suggests that Americans have limits on how far they will allow marketplace decisions to put them at individual risk. As with airline safety and banking, public support for regulation is being driven in part by the anxiety the public feels over the occurrence of visible events questioning the behavior of managed care plans, as well as the problems people experience in their own lives. As a result, debate about regulation of the managed care industry is likely to be a permanent fixture on the health care agenda for years to come.


Notes
1
“Health Care in America: Your Money or Your Life, ” Economist, March 1998, pp. 23–26.
2
See, for example, Monroe, A. D. “Consistency Between Public Preferences and National Policy Decisions.” American Journal of Political Science, January 1979, pp. 3–19; Monroe, A. D. “American Party Platforms and Public Opinion.” American Journal of Political Science, February 1983, pp. 27–42; Page, B. I., and Shapiro, R. Y. “Effects of

-224-

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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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