Health Law and Policy Commons^™

Catholic Health Care And The Diocesan Bishop, John J. Coughlin

Journal Articles

Over the course of the last decade, the provision of health care in the United States has been undergoing a radical transformation. The days when an insurer, such as Blue Cross and Blue Shield, paid a standard fee to a physician who provided a specified service to an individual patient are passing rapidly. This fee-for-service concept, which characterized American health care from the end of World War II until the 1990s, is being supplanted by a variety of arrangements that fall under the general rubric of "managed care." The fundamental approach of managed care is to provide the patient with …

Mid-Atlantic Ethics Committee Newsletter, Fall-Winter 1999

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Standards Of Care And Standard Form Contracts: Distinguishing Patient Rights And Consumer Rights In Managed Care, Wendy K. Mariner

Faculty Scholarship

There is hardly a legislature in the country that is not currently debating the issue of patient rights in managed care. Not surprisingly, legislators, as well as reporters covering the debate, have called upon George J. Annas, Edward R. Utley Professor of Health Law and Chair of the Health Law Department at Boston University, for information and advice. Professor Annas has earned the title of "father of patient rights" for his decades of research, writing, and advocacy on behalf of individuals who need health care and deserve justice.

Today, however, one might ask whether patient rights are compatible with managed …

Mid-Atlantic Ethics Committee Newsletter, Summer 1999

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Exit And Voice In American Health Care, Marc A. Rodwin

University of Michigan Journal of Law Reform

Until the 1960s, the main way for patients to affect health care institutions was by choosing their doctors or hospitals or leaving those with which they were dissatisfied. They had few avenues to exert their voice to bring about change through complaints, politics, or other means. The balance between exit and voice shifted in the 1960s, as the women's health and disability rights movements brought about change by increased use of political voice and, to a lesser degree, by exit. With the growth of managed care since the 1980s, enrolled individuals have had fewer opportunities for exit and greater potential …

Questioning Traditional Antitrust Presumptions: Price And Non-Price Competition In Hospital Markets, Peter J. Hammer

University of Michigan Journal of Law Reform

Hospital mergers challenge basic assumptions about the effects of market power in the health care industry. Antitrust courts have struggled with claims that hospital mergers may in fact reduce costs and lower prices. This Article assesses the validity of these economic claims in the context of an industry that has undergone radical transformations in recent years. The Article also explores how such arguments should be treated as a matter of antitrust doctrine in an area of the law that relies heavily on market share presumptions and rule-based decision making. The Article contends that courts should employ a total welfare standard …

Playing Doctor: Corporate Medical Practice And Medical Malpractice, E. Haavi Morreim

University of Michigan Journal of Law Reform

Although health plans once existed mainly to ensure that patients could pay for care, in recent years managed care organizations (MCOs) have attempted to limit expenditures by exercising significant influence over the kinds and levels of care provided. Some commentators argue that such influence constitutes the practice of medicine, and should subject MCOs to the same medical malpractice torts traditionally brought against physicians. Others hold that MCOs engage only in contract interpretation, and do not literally practice medicine.

This Article begins by arguing that traditional common law doctrines governing corporate practice of medicine do not precisely apply to the current …

How Not To Think About "Managed Care", Jacob S. Hacker, Theodore R. Marmor

University of Michigan Journal of Law Reform

The claim of this Article is that the concept of "managed care," like many concepts now prominent in commentary about medical care finance and delivery in the United States, is incoherent and thus a barrier to useful analysis. To demonstrate this conclusion, we first discuss the managerial context in which managed care claims have arisen and outline the diverse trends to which the category is regularly and confusingly applied. We then suggest an alternative approach to characterizing recent changes in medical care and show how this approach alters and deepens our understanding of recent economic and political developments. We conclude …

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 …

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 …

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 …

Mid-Atlantic Ethics Committee Newsletter, Spring 1999

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Ethical Issues In Managed Care: Can Thetraditional Physician-Patient Relationship Be Preserved In The Era Of Managed Care Or Should It Be Replaced By A Group Ethic?, Eugene C. Grochowski

University of Michigan Journal of Law Reform

Over the last decade managed care has become the dominant form of health care delivery, because it has reduced the cost of health care; however, it has also created serious conflicts of interest for physicians and has threatened the integrity of the traditional physician-patient relationship. In this Article, Dr. Grochowski argues that the efficiencies created by managed care are one time savings and will not in the long run reduce the rate of rise of health care expenditures without a concomitant plan to ration health care. He explores the traditional physician-patient relationship and concludes:

• a) that while rationing of health …

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

University of Michigan Journal of Law Reform

As American health care moves from a professionally dominated to a market-dominated 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 …

The Charleston Policy: Substance Or Abuse?, Kimani Paul-Emile

Michigan Journal of Race and Law

In 1989, the Medical University of South Carolina (MUSC) adopted a policy that, according to subjective criteria, singled out for drug testing, certain women who sought prenatal care and childbirth services would be tested for prohibited substances. Women who tested positive were arrested, incarcerated and prosecuted for crimes ranging from misdemeanor substance possession to felony substance distribution to a minor. In this Article, the Author argues that by intentionally targeting indigent Black women for prosecution, the MUSC Policy continued the United States legacy of their systematic oppression and resulted in the criminalizing of Black Motherhood.

Shaping Regional Economies To Sustain Quality Work: The Cooperative Health Care Network, Peter R. Pitegoff

Faculty Publications

This chapter chronicles a creative response to social retrenchment, a saga of strategic deployment of accessible resources and a reshaping of regional economic forces for the benefit of targeted labor markets. While charting its own course, CHCB is part of a mutually supportive network of health care employers and trainers, including successful home care companies in Philadelphia and the South Bronx. Together, these three corporations form the core of the Cooperative Health Care Network and employ over 500 home health aides. About 80 percent of the employees were formerly dependent on public assistance. The network [network] experience and their applicability …

Justification By Faith, Carl E. Schneider

Articles

In June 1997 a sixteen-year-old girl named Shannon Nixon began to feel ill. Her parents belonged to the Faith Tabernacle Church, one of a number of American sects which believe that illness should be treated spiritually rather than medically. Accordingly, the Nixons prayed for Shannon and took her to be anointed at their church. Shannon reported that she felt better and that the spiritual treatment had gained her her victory-her recovery. Before long, however, Shannon again felt ill. She became weaker and weaker and then fell into a coma. A few hours later she died. An autopsy revealed that she …

Mid-Atlantic Ethics Committee Newsletter, Fall-Winter 1998

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Mid-Atlantic Ethics Committee Newsletter, Summer 1998

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Chicago Hope Meets The Chicago School, Gail B. Agrawal

Michigan Law Review

Twenty-five years after the enactment of the Federal Health Maintenance Organization Act and nearly five years after the failure of proposed federal health care reform, managed care has come to dominate the medical marketplace. As a result, the relationships among patients, payers, and physicians have changed fundamentally and dramatically. In this market-driven environment, health care - how much it costs, who receives treatment, and who pays for it - may have surpassed the weather as a topic of everyday conversation at dinner tables and water coolers across the country. In the popular press, reports concerning managed care, usually derogatory, are …

How Many Libertarians Does It Take To Fix The Health Care System?, Thomas L. Greaney

Michigan Law Review

There's an old joke about a Southern preacher who is asked whether he believes in the sacrament of infant baptism. "Believe in it?" thunders the preacher. "Hell, son, I've seen it done." In Mortal Peril: Our Inalienable Right to Health Care?, Richard Epstein gives testimony that markets should be left unfettered to distribute health care services. Arguing from first principles, he aims to persuade that the messy, confusing business of health care is best dealt with by simple legal rules: permit free contracting, countenance no government-induced subsidies, recognize no positive rights. One leaves this particular revival tent feeling he …

Mid-Atlantic Ethics Committee Newsletter, Spring 1998

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Aids As A Chronic Illness: A Cautionary Tale For The End Of The Twentieth Century, Linda C. Fentiman

Elisabeth Haub School of Law Faculty Publications

The result of the monumental shifts in the structure and financing of health care delivery is that at the very time that medical innovations have made possible significant improvements in the quality and quantity of life for people with chronic illnesses, those who are responsible for paying for Americans' health care, in government and the private sector, seem to have finally said “Enough! We must cut costs, and cut them dramatically, and the simplest, most direct way of cutting costs is to deny coverage for certain kinds of treatments and certain kinds of illnesses.” People with HIV and AIDS are …

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 …

Racial Disparities In The Delivery Of Health Care, Barbara A. Noah

Faculty Scholarship

This Article focuses on the role of conscious and unconscious racial bias in the delivery of care; it does not begin to address the larger issue of inadequate access to care at the outset. Improving access to health care for minorities will undoubtedly have a positive effect on these groups' overall health status; however, to the extent that racial bias in the delivery of care exists apart from problems of inadequate access, the disparity in health status between whites and African Americans will no doubt continue.

Part II of this Article describes racial disparities in a variety of health care …

Primum Non Nocere: The Expanding "Honest Services" Mail Fraud Statute And The Physician-Patient Fiduciary Relationship, Gregory D. Jones

Vanderbilt Law Review

In one case, a physician refers a patient to a certain hospital in return for an undisclosed referral fee from the hospital. In another, a physician decides not to refer a patient to a specialist for further examination. The physician, however, does not disclose to the patient that part of the cost of sending the patient to the specialist would come out of the physician's potential earnings. In the previous examples, has the physician breached her fiduciary duty to the patient by not disclosing her own financial interest in the patient's treatment? If so, the physician could be guilty of …

The Medical Savings Account Provision Of The Hipaa: Is It Sound Health And Tax Policy?, Danshera Cords

Seattle University Law Review

This Comment argues that the Medical Savings Account (MSA) provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) fails to meet the goals of either tax policy or health policy. As a result of this failure, the demonstration program should be redesigned to provide valid and reliable information about whether the availability of tax-preferred MSAs will decrease the affordability of health care and its availability to the less healthy.

Mid-Atlantic Ethics Committee Newsletter, Fall-Winter 1997

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Common Problems, Different "Solutions": Learningfrom International Approaches To Improving Medicalservices Access For Underserved Populations, Morris Barer, Laura Wood

Dalhousie Law Journal

Canada shares with most OECD countries the problems associated with inequitable geographic access to physician services, and improving the geographic distribution of physicians is a policy preoccupation of all ministries of health in Canada today. Recent court challenges by newly-entering physicians to physician supply controls in B. C. and New Brunswick have brought the issue into sharp relief. The authors explore the degree to which the provinces have adopted common approaches to addressing these problems, and whether Canadian policy-makers have learned from international experience. The recent judgment in the Waldman case in B.C. is analyzed in terms of likely implications …