Health Law and Policy Commons^™

Managed Care Regulation: Can We Learn From Others? The Chilean Experience, Timothy Stoltzfus Jost

University of Michigan Journal of Law Reform

Because the United States relies on private insurance for financing health care to a much greater degree than do other nations, and because managed care as a form of private insurance is further developed in the United States than elsewhere, it is arguable that we have little to learn from other nations about managed care regulation. This Article tests this hypothesis with respect to Chile, a country where private insurance is widespread and managed care is emerging. It concludes that by studying the experience of other nations we might gain a larger perspective on the context of our concerns in …

Accountable Managed Care: Should We Be Careful What We Wish For?, David A. Hyman

University of Michigan Journal of Law Reform

Managed care is exceedingly unpopular of late. Many people believe that the problem is managed care organizations (MCOs) are unaccountable. Indeed, for many people, the creation of tort-based accountability for MCOs is the touchstone for assessing legislative "reform." The case for tort-based accountability is actually quite complex, and the merits of tort-based accountability cannot be resolved with sound bites and bad anecdotes. Tort-based accountability has both costs and benefits, and little attention has been paid to the extent to which alternatives to tort-based accountability are found in existing institutional arrangements.

This Article systematically considers the extent to which alternatives to …

Managed Care- The First Chapter Comes To A Close, Sallyanne Payton

University of Michigan Journal of Law Reform

Introduction to the symposium, Managed Care: What's the Prognosis: Managing Care in the Next Century.

Clearing The Way For An Effective Federal-State Partnership In Health Reform, Eleanor D. Kinney

University of Michigan Journal of Law Reform

At century's end, states have assumed a very different role in the design, implementation, and operation of health service programs than they did twenty-five years ago. In the current volatile political atmosphere particularly at the federal level, states have taken up the mantle of healthcare reform in the final years of the 1990s. Yet there remain problems and difficulties with the current federal-state relationship in health reform. The critical question is whether states can successfully accomplish genuine reform given its politically charged, complex and costly nature. This question takes on particular significance for the most important reform-expanding coverage to the …

Establishing New Legal Doctrine In Managed Care: A Model Of Judicial Response To Industrial Change, Peter D. Jacobson, Scott D. Pomfret

University of Michigan Journal of Law Reform

Courts are struggling with how to develop legal doctrine in challenges to the new managed care environment. In this Article, we examine how courts have responded in the past to new industries or radical transformations of existing industries. We analyze two historical antecedents, the emergence of railroads in the nineteenth century and mass production in the twentieth century, to explore how courts might react to the current transformation of the health care industry.

In doing so, we offer a model of how courts confront issues of developing legal doctrine, especially regarding liability, associated with nascent or dramatically transformed industries. Our …

The Competitive Impact Of Small Group Health Insurance Reform Laws, Mark A. Hall

University of Michigan Journal of Law Reform

This Article reports on findings from an extensive study of small group health insurance market reforms in seven states, enacted during the early 1990s. After summarizing the content and purpose of these reforms, this evaluation focuses on the impact these reforms have had on the nature and degree of market competition. The principal findings are: (1) small group health insurance markets are highly competitive, both in price and in product innovation and diversity; (2) although some insurers have left some or all of these states in part because of these reforms, an ample number of active competitors remain, even in …

Regulating Doctors, Carl E. Schneider

Articles

Alawyer today can hardly speak to a doctor--or even be treated by one-without being assailed by lawyer jokes. These jokes go well beyond good-humored badinage and pass the line into venom and gall. They reflect, I think, the sense many doctors today have that they are embattled and endangered, cruelly subject to pervasive and perverse controls. This is puzzling, almost to the point of mystery. Doctors have long been the American profession with the greatest social prestige, the greatest wealth, and the greatest control over its work. Indeed, what other profession has been as all-conquering? One may need to go …

Competing On Quality Of Care: The Need To Develop A Competition Policy For Health Care Markets, William M. Sage, Peter J. Hammer

Faculty Scholarship

As American health care moves from a professionally dominated to a marketdominated model, concerns have been voiced that competition, once unleashed, will focus on price to the detriment of quality. Although quality has been extensively analyzed in health services research, the role of quality in competition policy has not been elucidated. While economists may theorize about non-price competition, courts in antitrust cases often follow simpler models of competition based on price and output, either ignoring quality as a competitive dimension or assuming that it will occur in tandem with price competition. This unsystematic approach is inadequate for the formulation of …

Canada's Generalist Training: Are There Lessons For The United States?, Lee Hawkins

National Health Policy Forum

Addressing the premise of an inappropriate skewing of the U.S. medical education system toward specialty medicine, this issue brief compares and contrasts the U.S. and Canadian graduate medical education (GME) systems, including the organization and financing of each. The issue brief also explores various lessons that might be learned from the Canadian GME system, such as full integration of primary care and GME and the use of incentives to achieve desired policy goals.

An Analysis Of Implementation Issues Relating To Chip Cost-Sharing Provisions For Certain Targeted Low Income Children, Sara J. Rosenbaum, Anne Rossier Markus, Dylan Roby

Health Policy and Management Issue Briefs

This analysis, prepared for the Health Care Financing Administration and the Health Resources and Services Administration, examines issues that arise under laws designed to avert excessive cost-sharing in the case of low income families whose children participate in the State Children’s Health Insurance Program (CHIP). High cost-sharing has been shown to significantly affect children’s participation in insurance programs, as well as their utilization of health services. As a result, the Federal CHIP legislation, while permitting cost-sharing under certain circumstances, also places limitations on the total amount of cost-sharing to which families can be exposed for services covered by State CHIP …

Shaping Responsible Behavior: Lessons From The Aids Front, Harlon L. Dalton

Washington and Lee Law Review

No abstract provided.

Reducing Medical Error: Can You Be As Safe In A Hospital As You Are In A Jet?, Lisa Sprague

National Health Policy Forum

This issue brief looks at the incidence of error in the health care system, opportunities for a systems-based approach to error reduction, and changes needed in health system culture and training. The lessons of human factors research are considered, with examples of their application in the aviation industry. The paper reviews some error-reduction and patient-safety initiatives undertaken by private-sector organizations and by the Veterans Health Administration.

"Being Human": Cloning And The Challenges For Public Policy, Karen H. Rothenberg

Faculty Scholarship

No abstract provided.

Substance Abuse Prevention: Could An Improved D.A.R.E. Program Help Bridge The Gap Between Research And Practice?, Colomba Sirica

National Health Policy Forum

This issue brief provides background information on the popular Drug Abuse Resistance Education (D.A.R.E.) program, begun in 1983 and supported by education and law enforcement communities throughout the country to provide drug abuse prevention programs in schools. It describes recent efforts to conduct evaluative studies to assess the short- and long-term impact of the D.A.R.E. curriculum on drug-using behavior of children and youth and the new dialogue opening between D.A.R.E. proponents and the research community.

Hipaa As A Regulatory Model: Early Experiences And Future Prospects, Karl Polzer

National Health Policy Forum

In the context of the debate over bolstering consumer protection in health care without imposing excessive costs or onerous regulatory requirements, this paper examines the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as a regulatory model. The paper reviews the provisions of the legislation, examines the roles of the Department of Labor and the Health Care Financing Administration in implementing HIPAA, raises issues surrounding implementation and enforcement, and examines the usefulness of the HIPAA model as a vehicle for applying consumer protection measures.

Mid-Atlantic Ethics Committee Newsletter, Spring 1999

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Harming Future Persons: Obligations To The Children Of Reproductive Technology, Philip G. Peters Jr.

Faculty Publications

Two paradigms dominate contemporary ethical and legal debate about the risks posed to children who owe their lives to reproductive technology. One asks whether the children have lives so tragic that life itself is harmful. The other approach asks whether children so conceived are likely to enjoy a minimally decent existence. Although the two approaches have quite different analytic foundations, they share one crucial trait. Each concludes that children who owe their lives to reproductive technology are harmed only when that technology causes genuinely catastrophic injuries.Because these conventional paradigms define harmful conduct exclusively by reference to the magnitude of the …

The Department Of Defense Dna Repository: Practical Analysis Of The Government's Interest And The Potential For Genetic Discrimination, Elizabeth Reiter

Buffalo Law Review

No abstract provided.

Disabled Former Employees Under The Ada: Unprincipled Decisions And Unpalatable Results, Austin L. Mcmullen

Vanderbilt Law Review

A number of disabled former employees have turned to the Americans with Disabilities Act ("ADA") to redress alleged discrimination in their termination or in the benefit plans of their former employers.' Several courts, however, have held that these plaintiffs are not "qualified individual[s] with a disability," and, therefore, may not recover under the ADA. Other courts of appeals have recently found the ADA's proscription of discrimination in the "terms, conditions, and privileges of employment" to contradict the definition of qualified individuals. These courts resolved the ambiguity by allowing disabled former employees a federal right to sue their former employers for …

Margins As Measures: Gauging Hospitals' Financial Health, Karen Matherlee

National Health Policy Forum

Recognizing the considerable controversy over ways to measure hospitals' financial viability, this issue brief reviews various ways to assess their fiscal strength. The paper looks first at operating margins, traditional measures that some experts say are inadequate when considered alone. It then explores several recommendations: (a) net income, liquidity and cash flow, and debt burden, suggested by the National Advisory Panel; (b) factors that determine year-to-year changes in hospitals costs, such as hospital input price inflation, changes in care patterns, and the complexity of patients treated, put forth by the Medicare Payment Advisory Commission; and (c) 35 financial indicators and …

Examining The Links Between Retirement And Health Insurance: Implications For Medicare Eligibility, Nora Super

National Health Policy Forum

This issue brief examines trends in labor force participation and health care coverage for early retirees, as well as the relationship between retirement and health insurance and health status.

Providing Outpatient Prescription Drugs Through Medicare: Can We Afford To? Can We Afford Not To?, Robin J. Strongin

National Health Policy Forum

The continuing debate over the issue of Medicare coverage for outpatient prescription drugs gave rise to this background paper, which discussed several key questions: Whose responsibility is it to provide coverage? Who should be covered? What should be covered? Who should pay for prescription drug coverage? How should costs be controlled? In addition, the paper explored options for structuring a Medicare outpatient prescription drug benefit. It also contained a glossary.

Bragdon V. Abbott: Is Asymptomatic Hiv A Per Se Disability Under The Americans With Disabilities Act?, Amy C. Reeder

Mercer Law Review

In Bragdon v. Abbott, the United States Supreme Court held that asymptomatic HIV is a "disability" under the Americans with Disabilities Act ("ADA") because it is a physical impairment that substantially limits the major life activity of reproduction. It further held that determining whether a plaintiff is entitled to relief requires objective and particularized evidence of the risks to the defendant under the "direct threat" provisions of the ADA. This Casenote focuses exclusively on the "disability" holding.

Physicians As Advocates, William M. Sage

Faculty Scholarship

The principal theme of this Article is that many dimensions of physicians' advocacy in managed care remain to be established, and those dimensions may turn out to be inconsistent with one another or with normative goals for the health care system. Specifically, attempting to map physician behavior onto an advocacy template created for lawyers raises three difficult questions. First, given the undisputed importance of clinical expertise to an efficient health care system, should physicians' primary role be to advocate for causes or to direct the provision of care? Second, would the medical professions' reputation for independent competence withstand the adversarial …

Welfare Reform And Its Impact On Medicaid: An Update, Judith D. Moore

National Health Policy Forum

Welfare reform, enacted in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), had a profound impact on the Medicaid program, delinking Medicaid from the new TANF program and for the first time allowing Medicaid eligibility to be divorced from welfare status. This paper reviews the national impact of this decoupling, describing research, implementation activities, and the impact of new state welfare programs on health programs in general.

Biological Terrorism: Is The Health Care Community Prepared?, Robin J. Strongin

National Health Policy Forum

This issue brief provides an overview of biological warfare and discusses the role of the Centers for Disease Control (CDC) and state health departments in detecting biologic agents. The brief also highlights the issue of threat assessment and discusses ways to improve the current level of preparedness as well as steps needed to convert the public health system into our best form of civil defense.

Medicare Hmo Pullouts: What Do They Portend For The Future Of Medicare+Choice?, Nora Super

National Health Policy Forum

National policymakers became alarmed in the fall of 1998 when, contrary to expectations, nearly 100 Medicare HMOs announced their decisions to pull out of Medicare in certain areas or to reduce their service areas. This issue brief explores the reasons plans withdrew from certain areas, the Balanced Budget Act of 1997 provisions that most directly influenced these decisions, the impact of the withdrawals on Medicare beneficiaries, and policy options for ensuring the viability of the Medicare+Choice program.

Reproductive Technology Comes Of Age, Lori B. Andrews

All Faculty Scholarship

No abstract provided.

Filling The Geriatric Gap: Is The Health System Prepared For An Aging Population?, Janet Firshein

National Health Policy Forum

This issue brief explores the field of geriatrics, the ways practitioners meet the health care needs of the elderly, training gaps, and the impact of Medicare payment policies on the delivery of health care to older Americans.

Informing, Claiming, Contracting: Enforcement In The Managed Care Era, Louise G. Trubek

Annals of Health Law and Life Sciences

Professor Trubek describes the role of the states in patient and consumer protection in the managed care era. In particular, this article focuses on the managed care patient protection mechanisms used in Wisconsin: informing consumers, encouraging dispute resolution and influencing contracts. The discussion includes an analysis of the effects of these mechanisms on the actors in the health care regulatory area and concludes with an assessment of the actors' adaptations.