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Full-Text Articles in Law
The Effect Of Any Willing Provider And Freedom Of Choice Laws On Prescription Drug Expenditures, Jonathan Klick, Joshua D. Wright
The Effect Of Any Willing Provider And Freedom Of Choice Laws On Prescription Drug Expenditures, Jonathan Klick, Joshua D. Wright
All Faculty Scholarship
Any Willing Provider and Freedom of Choice laws restrict the ability of managed care entities, including pharmacy benefit managers, to selectively contract with providers. The managed care entities argue this limits their ability to generate cost savings, while proponents of the laws suggest that such selective contracts limit competition, leading to an increase in aggregate costs. We examine the effect of state adoption of such laws on total state healthcare spending, finding that any willing provider/freedom of choice laws are associated with cost increases of at least 3 percent. These results suggest that these laws are harmful from a spending …
Giving Meaning To 'Meaningful Access' In Medicaid Managed Care, Mary Crossley
Giving Meaning To 'Meaningful Access' In Medicaid Managed Care, Mary Crossley
Articles
As states seek to shift Medicaid recipients with disabilities out of traditional fee-for-service settings and into managed care plans, vexing questions arise about the impact on access to needed care and providers for beneficiaries with medically complex needs. With many states expanding their Medicaid program as part of health care reform and cost-containment pressures continuing to mount, this movement will likely accelerate over the next several years. This Article examines the possibility that disability discrimination law might provide a mechanism for prodding states in the planning stage to anticipate and plan for likely access issues, as well as for challenging …
When Patients Say No (To Save Money): An Essay On The Tectonics Of Health Law., Mark A. Hall, Carl E. Schneider
When Patients Say No (To Save Money): An Essay On The Tectonics Of Health Law., Mark A. Hall, Carl E. Schneider
Articles
The ultimate aim of health care public policy is good care at good prices. Managed care stalled at achieving this goal by trying to influence providers, so health policy has turned to the only market-based option left: treating patients like consumers. Health insurance and tax policy are now pressuring patients to spend their own money when they select health plans, providers, and treatments. Expecting patients to choose what they need at the price they want, consumerists believe that market competition will constrain costs while optimizing quality. This classic form of consumerism is today's watchword. This Article evaluates this ideal type …
Competition Policy And Organizational Fragmentation In Health Care, Thomas L. Greaney
Competition Policy And Organizational Fragmentation In Health Care, Thomas L. Greaney
All Faculty Scholarship
A central challenge for all health care reform proposals currently being discussed is finding the means to effectively channel market forces given many deeply embedded features of our system and the peculiar economics of health care delivery and financing. This essay traces the path of competition law in health care and explains its chicken-and-egg relationship with provider organizational arrangements. It explores a central puzzle for future health care policy: why have market forces failed to counteract organizational fragmentation? Answering this question requires an understanding of why competition policy is inexorably linked to the organizational structures of health care providers and …
The Patient Life: Can Consumers Direct Health Care?, Carl E. Schneider, Mark A. Hall
The Patient Life: Can Consumers Direct Health Care?, Carl E. Schneider, Mark A. Hall
Articles
The ultimate aim of health care policy is good care at good prices. Managed care failed to achieve this goal through influencing providers, so health policy has turned to the only market-based option left: treating patients like consumers. Health insurance and tax policy now pressure patients to spend their own money when they select health plans, providers, and treatments. Expecting patients to choose what they need at the price they want, consumerists believe that market competition will constrain costs while optimizing quality. This classic form of consumerism is today's health policy watchword. This article evaluates consumerism and the regulatory mechanism …
The Supreme Court's Limitation Of Managed-Care Liability, Wendy K. Mariner
The Supreme Court's Limitation Of Managed-Care Liability, Wendy K. Mariner
Faculty Scholarship
This article summarizes and critiques the U.S. Supreme Court's decision in Aetna Health Inc. v. Davila, which limited managed care organizations' liability for negligent decisions about the care of patients in private employer-sponsored health plans governed by ERISA. It contrasts the Court's dichotomous view of health benefit plans, in which insurers administer contracts and treating physicians make medical judgments, with the more complicated relationships that affect decisions about both coverage and treatment.
Images Of Health Insurance In Popular Film: The Dissolving Critique, Elizabeth Pendo
Images Of Health Insurance In Popular Film: The Dissolving Critique, Elizabeth Pendo
All Faculty Scholarship
Several recent films have villainized the health insurance industry as central elements of their plots. This Article examines three of those films: Critical Care, The Rainmaker, and John Q. It analyzes these films through the context of the consumer backlash against managed care that began in the 1990s and shows how these films reflect the consumer sentiment regarding health insurance companies and the cost controlling strategies they employ. In addition, the Article identifies three key premises about health insurance in the films that, although exaggerated and incomplete, have significant factual support. Ultimately, the author argues that, despite their passionately critical …
Images Of Health Insurance In Popular Film: The Dissolving Critique, Elizabeth Pendo
Images Of Health Insurance In Popular Film: The Dissolving Critique, Elizabeth Pendo
Articles
Several recent films have villainized the health insurance industry as central elements of their plots. This Article examines three of those films: Critical Care, The Rainmaker, and John Q. It analyzes these films through the context of the consumer backlash against managed care that began in the 1990s and shows how these films reflect the consumer sentiment regarding health insurance companies and the cost controlling strategies they employ. In addition, the Article identifies three key premises about health insurance in the films that, although exaggerated and incomplete, have significant factual support. Ultimately, the author argues that, despite their passionately critical …
Physician Liability And Managed Care: A Philosophical Perspective, Dionne L. Koller
Physician Liability And Managed Care: A Philosophical Perspective, Dionne L. Koller
All Faculty Scholarship
Despite the emergence of managed health care and the resulting dramatic change in the role of the third-party payer in the physician-patient relationship, the liability standards applied to physicians largely have remained unchanged. This has created a tension between physicians' legal and ethical obligations, and the requirements imposed on the physician by managed health care. Specifically, the issue confronts the physician in the context of malpractice liability. Managed Care Organizations impose a significant amount of control over the way physicians practice medicine, often forcing physicians to ration care. Notwithstanding any beneficial cost savings that might result, this approach subjects the …
Patient Advocacy And Termination From Managed Care Organizations: Do State Laws Protecting Health Care Professional Advocacy Make Any Difference?, Linda C. Fentiman
Patient Advocacy And Termination From Managed Care Organizations: Do State Laws Protecting Health Care Professional Advocacy Make Any Difference?, Linda C. Fentiman
Elisabeth Haub School of Law Faculty Publications
This article will explore the history, implementation, and impact of state advocacy protection statutes. The article is in four major parts. The first Part provides an introduction to the concept of advocacy, both as it was understood at common law, and as it is presently interpreted by HCPs and MCOs. The article will also examine the phenomenon of HCPs' “deselection,” that is, the termination or non-renewal of their contracts with MCOs. In this context, the article will highlight the distinction between anecdote and data and emphasize the paucity of hard evidence to support either side's version of the truth about …
Slouching Toward Managed Care Liability: Reflections On Doctrinal Boundaries, Paradigm Shifts, And Incremental Reform, Wendy K. Mariner
Slouching Toward Managed Care Liability: Reflections On Doctrinal Boundaries, Paradigm Shifts, And Incremental Reform, Wendy K. Mariner
Faculty Scholarship
Following the seemingly endless debate over managed care liability, I cannot suppress thoughts of Yeats’s poem, “The Second Coming.” It is not the wellknown phrase, “Things fall apart; the centre cannot hold,” that comes to mind; although that could describe the feeling of a health-care system unraveling. The poem’s depiction of lost innocence — “The best lack all conviction, while the worst/Are full of passionate intensity” — does not allude to the legislature, the industry, the public, or the medical or legal profession. What resonates is the poem’s evocation of humanity’s cyclical history of expectation and disappointment, with ideas as …
Quality Control, Enterprise Liability, And Disintermediation In Managed Care, Nicole Huberfeld
Quality Control, Enterprise Liability, And Disintermediation In Managed Care, Nicole Huberfeld
Faculty Scholarship
The authors examine the potential of enterprise liability for managed care organizations in light of current health-care finance realities. They conclude that, despite the recent trend toward more loosely structured managed care organizations, such as disintermediated or patient-directed plans, plan-based enterprise liability best serves the goal of reducing medical injury by permitting a focus on entities with sufficient scope to translate liability pressure into support for systemic risk-reduction measures. Advancing plan-based enterprise liability in an era of disengaged managed care organizations will require an extension of tort liability to firms with little control but much influence over their business partners.
Genetic Testing, Genetic Medicine, And Managed Care, Mark A. Rothstein, Sharona Hoffman
Genetic Testing, Genetic Medicine, And Managed Care, Mark A. Rothstein, Sharona Hoffman
Faculty Publications
As modern human genetics moves from the research setting to the clinical setting, it will encounter the managed care system. Issues of cost, access, and quality of care will affect the availability and nature of genetic testing, genetic counseling, and genetic therapies. This articles explores such issues as professional education, coverage of genetic services, privacy and confidentiality, and liability. It concludes with a series of recommendations for the practice of genetic medicine in the age of managed care.
Testing For Genetic Traits: The Need For A New Legal Doctrine Of Informed Consent , Elizabeth B. Cooper
Testing For Genetic Traits: The Need For A New Legal Doctrine Of Informed Consent , Elizabeth B. Cooper
Faculty Scholarship
Innovative medical technology has made it possible to test whether you are at increased risk for certain types of cancer. The mere processing of a vial of blood can reveal whether you have a genetic predisposition to develop breast, ovarian, or prostate cancer, or other life-threatening conditions. The Human Genome Project, an international endeavor seeking to map our genetic structures, has facilitated this increasing ability to test for genetic flaws. It is expected that as the human genetic map is filled in, and as flaws in our fundamental building blocks are identified, there will be a concomitant drive to test …
Managed Care And Mental Health: Clinical Perspectives And Legal Realities, Jesse Goldner
Managed Care And Mental Health: Clinical Perspectives And Legal Realities, Jesse Goldner
All Faculty Scholarship
Managed care is beginning to dominate the delivery of mental health services. The Article reviews limitations on managed care's ability to deal adequately with mental illness. It discusses empirical and other research examining the use of primary care providers as gatekeepers and it explores utilization review mechanisms, focusing particularly on providers' responses to UR. The impact on quality, access and continuity of care on discrete populations is analyzed. The article then surveys a variety of legal issues in the regulation of managed care, particularly as they apply to the provision of mental health services. These include ERISA, parity and liability …
Managed Care, Assisted Suicide, And Vulnerable Populations, M. Cathleen Kaveny
Managed Care, Assisted Suicide, And Vulnerable Populations, M. Cathleen Kaveny
Journal Articles
While advocates of physician assisted suicide consider it a core aspect of individual autonomy legalizing the practice is extremely dangerous and puts the most vulnerable members of our society at risk. Legalized physician assisted suicide takes away the autonomy of the decision to die and makes it an option in a flawed healthcare system, where patients are often denied coverage for medical expenses by employer-sponsored benefit plans and medical insurers are concerned primarily with cutting costs spent on each patient. Complexities in the way that physicians are compensated under the current system of managed care is also eroding their responsibility …
How Many Libertarians Does It Take To Fix The Health Care System?, Thomas L. Greaney
How Many Libertarians Does It Take To Fix The Health Care System?, Thomas L. Greaney
All Faculty Scholarship
The libertarian prescription for health care reform is a admixture of deregulation and purportedly utilitarian calculation of social benefits and costs. In Mortal Peril: Our Inalienable Right to Health Care?, Richard Epstein's offers a stark roadmap that embraces an unfettered free market for health care services, indigent care left primarily to the charitable impulses of providers and no cross subsidies between classes, generations or other categories of citizens (including the sick and healthy). This review essay argues that the history, economics, and politics of health markets belie Epstein's abstract reasoning. Though much of the argument in Mortal Peril is written …
Rights And Efficiency In American Health Law, Maxwell Gregg Bloche
Rights And Efficiency In American Health Law, Maxwell Gregg Bloche
Georgetown Law Faculty Publications and Other Works
During the 1960s and 1970s, the individual rights revolution that swept through American society remade much of the nation's health law in its image. Sick people acquired the right to be told of the risks and benefits of proposed treatments and then to give thumbs-up or thumbs-down to their doctors' decisions. Successful suits for medical negligence went from rare to commonplace. Elderly and poor Americans achieved statutory rights of access to publicly funded healthcare, and courts burnished these rights with myriad procedural protections. The critically ill and their families won the right to refuse aggressive, life-sustaining treatments. Psychiatric patients acquired …
Medicaid Managed Care And Disability Discrimination Issues, Mary Crossley
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 …
Regulating For Efficiency In Health Care Through The Antitrust Laws, Thomas L. Greaney
Regulating For Efficiency In Health Care Through The Antitrust Laws, Thomas L. Greaney
All Faculty Scholarship
The need to evaluate the competitive consequences of cooperation among rivals has long posed a dilemma for antitrust enforcement. Collaboration can reduce rivalry, raise prices and otherwise reduce consumer welfare; at the same time cooperation among rivals carries the promise of creating cost savings, correcting market failures and producing other benefits. In many cases antitrust doctrine requires a balancing of the positive and negative effects of coordination. In health care, federal antitrust enforcement agencies have increasingly turned to regulatory tools including policy statements, advisory opinions, speeches and regulatory decrees settling cases to strike this balance. However, the agencies have paid …
Competitive Reform In Health Care: The Vulnerable Revolution, Thomas L. Greaney
Competitive Reform In Health Care: The Vulnerable Revolution, Thomas L. Greaney
All Faculty Scholarship
This article, written at the dawn of the era of "competitive reform" in health care examines the case and prospects for the introduction of competition in health care delivery and financing. It observes the failures of the ancienne regime of fee for service payment and professional sovereignty and discusses the benefits of market-oriented policy. Its contribution, still salient today, is the lesson that competition cannot succeed without regulation. It identifies legislative, professional, and cultural hurdles to effective implementation of competitive norms and policies that have impeded the success of competition policy in health care.