Regulating Managed Care Theory, Practice, and Future Options

by Altman, Stuart H.; Reinhardt, Uwe E.; Shactman, David

• ISBN13: 9780787947835
• ISBN10: 0787947830
• Edition: 1st
• Format: Hardcover
• Copyright: 1999-07-19
• Publisher: Jossey-Bass

Summary

What should be government's role in a market-oriented health care system? What's the appropriate amount of regulation? Who should regulate-states, federal government, or market forces? What role do the courts play in this regulation? Are there existing models that might guide leaders in designing an effective regulatory structure? Welcome to the great managed care debate. In Regulating Managed Care, twenty-six of the nation's leading health policy experts give health care administrators, clinicians, and policy makers insight into the issues behind this critical exchange and provide leaders with a road map to assess the policy options available to protect the quality of our health care delivery system. "This collection of papers, from an extraordinary group of authors, makes a valuable contribution to the ongoing policy debate and will be of interest to anyone concerned with the future of our health care system."---Charles A. Sanders, retired chairman and CEO Glaxo Inc. and former general director, Massachusetts General Hospital

Author Biography

STUART H. ALTMAN is the Sol C. Chaikin Professor of National Health Policy and chair, Council on the Economic Impact of Health System Change, Institute for Health Policy, Heller Graduate School, Brandeis University. He has held key health policy offices for Presidents Carter, Reagan, Bush, and Clinton. UWE E. REINHARDT is James Madison Professor of Political Economy, Princeton University. He is regularly quoted in the New York Times, Wall Street Journal, Health Affairs, and other publications. DAVID SHACTMAN is project director, Council on the Economic Impact of Health System Change, Institute for Health Policy, Heller Graduate School, Brandeis University.

Table of Contents

Foreword	ix
Steven A. Schroeder
Acknowledgments	xiii
The Editors	xv
The Contributors	xvii
Introduction: The Philosophy of Regulation	xxi
Stuart H. Altman
Brian Rosman
Section I: The Role of Regulation in a Market-Oriented Health Care System	1	(86)
Regulating Managed Care: An Overview	5	(24)
Walter Zelman
The Current Status of State and Federal Regulation	29	(24)
Patricia A. Butler
Why Should Managed Care Be Regulated?	53	(22)
Mark Pauly
Marc L. Berger
Macro- Versus Microregulation	75	(12)
Thomas Rice
Section II: Regulatory Issues	87	(118)
Consumer Choice Under ``Private Health Care Regulation''	91	(26)
Uwe E. Reinhardt
The Long-Term Care Ombudsman Program: A Model for Health Care Consumers	117	(18)
William F. Benson
Ensuring Equal Access to Care	135	(10)
Brian Biles
David Sandman
Regulating Quality and Clinical Practice	145	(15)
William L. Roper
The Scope of Managed Care Liability	160	(29)
David M. Keepnews
ERISA and the Regulation of Group Health Plans	189	(16)
Craig Copeland
William L. Pierron
Section III: Perspectives on Regulation	205	(94)
The Public: Understanding the Managed Care Backlash	209	(20)
Robert J. Blendon
Mollyann Brodie
John M. Benson
Drew E. Altman
Larry Levitt
Tina Hoff
Larry Hugick
A Foundation Perspective: Core Principles for Regulating Health Care Quality	229	(10)
Karen Davis
David Sandman
The Managed Care Industry: Balancing Market Forces and Regulation	239	(24)
Karen Ignagni
Regulation from a Consumer's Perspective	263	(13)
Ronald F. Pollack
Regulation from an Insurance Industry Perspective	276	(6)
Bill Gradison
Regulation Misses the Big Issue---The Uninsured	282	(17)
Larry S. Gage
Section IV: Managed Care Regulation in Practice	299	(46)
Creating Standards: A Practical Approach	301	(11)
Phil Nudelman
California's Struggle with Regulation	312	(19)
Sara J. Singer
Alain C. Enthoven
The Cost of Regulation: How the Estimates Vary	331	(14)
Allen Dobson
Caroline Steinberg
Index	345