Law Commons^™

How Liability Insurers Protect Patients And Improve Safety, Tom Baker, Charles Silver

All Faculty Scholarship

Forty years after the publication of the first systematic study of adverse medical events, there is greater access to information about adverse medical events and increasingly widespread acceptance of the view that patient safety requires more than vigilance by well-intentioned medical professionals. In this essay, we describe some of the ways that medical liability insurance organizations contributed to this transformation, and we catalog the roles that those organizations play in promoting patient safety today. Whether liability insurance in fact discourages providers from improving safety or encourages them to protect patients from avoidable harms is an empirical question that a survey …

Health Care's Market Bureaucracy, Allison K. Hoffman

All Faculty Scholarship

The last several decades of health law and policy have been built on a foundation of economic theory. This theory supported the proliferation of market-based policies that promised maximum efficiency and minimal bureaucracy. Neither of these promises has been realized. A mounting body of empirical research discussed in this Article makes clear that leading market-based policies are not efficient — they fail to capture what people want. Even more, this Article describes how the struggle to bolster these policies — through constant regulatory, technocratic tinkering that aims to improve the market and the decision-making of consumers in it — has …

Health Care Spending And Financial Security After The Affordable Care Act, Allison K. Hoffman

All Faculty Scholarship

Health insurance has fallen notoriously short of protecting Americans from financial insecurity caused by health care spending. The Patient Protection and Affordable Care Act (“ACA”) attempted to ameliorate this shortcoming by regulating health insurance. The ACA offers a new policy vision of how health insurance will (and perhaps should) serve to promote financial security in the face of health care spending. Yet, the ACA’s policy vision applies differently among insured, based on the type of insurance they have, resulting in inconsistent types and levels of financial protection among Americans.

To examine this picture of inconsistent financial protection, this Article offers …

Health Insurance, Risk, And Responsibility After The Patient Protection And Affordable Care Act, Tom Baker

All Faculty Scholarship

This essay explores the new social contract of healthcare solidarity through private ownership, markets, choice, and individual responsibility embodied in the Patient Protection and Affordable Care Act. This essay first explains the four main health care risk distribution institutions affected by the Act – Medicare, Medicaid, the individual and small employer market, and the large group market – with an emphasis on how the Act changes those institutions and how they are financed. The essay then describes the “fair share” approach to health care financing embodied in the Act. This approach largely rejects the actuarial fairness vision of what constitutes …

The Effects Of Malpractice Tort Reform On Defensive Medicine, Heather M. O'Neill, Katherine D. Hennesy

Business and Economics Faculty Publications

Medical malpractice crises occur across states to differing degrees, thus the proposed changes in state tort reforms differ accordingly. The primary overt goals of tort reform aim to address: rising medical malpractice insurance rates, increased frequency and severity of awards, and the increased incidence of doctors shuttering offices or fleeing states due to untoward malpractice environments. A secondary goal of tort reform is to reduce health care costs attributed to malpractice costs. Clearly, as malpractice tort reforms are debated in state capitols and reforms take place, the effects of the reforms on the goals above can be examined. However, there …

The Effects Of Malpractice Tort Reform On Defensive Medicine, Katherine D. Hennesy, Heather M. O'Neill

Business and Economics Faculty Publications

Positive defensive medicine occurs when physicians order additional tests or procedures primarily to avoid malpractice liability. This paper shows the degree of defensive medicine occurring across states is related to the malpractice environment in the states. As the environment changes due to malpractice tort reform, defensive medicine practices also change. This paper shows the existence of positive defensive medicine and how it adds to total health care expenditures for head trauma victims in 23 states in 2000. Moreover, given different malpractice environments across states, we witness variations in defensive medicine practices leading to differences in health care expenditures.

Medicaid Managed Care And Disability Discrimination Issues, Mary Crossley

Articles

This article examines issues potentially raised under the Americans with Disabilities Act (ADA) by states' decisions whether and how to include disabled Medicaid recipients in the massive shift towards Medicaid managed care. Part II briefly examines the special issues that disabled Medicaid recipients pose with respect to managed care enrollment. These include issues of cost, quality, access, and program design and implementation. Part III describes various approaches that state programs have taken or are proposing to take with respect to the enrollment of disabled Medicaid recipients in managed care. These approaches range from simply excluding the SSI population from managed …