The Law and Health Care Organization and Finance

by Furrow, Barry R.; Greaney, Thomas L.; Johnson, Sandra H.; Jost, Timothy Stoltzfus; Schwartz, Robert L.

• ISBN13: 9780314251879
• ISBN10: 0314251871
• Edition: 4th
• Format: Paperback
• Copyright: 2001-07-01
• Publisher: West Group

Table of Contents

Preface	v
Acknowledgments	vii
Table of Cases	xxiii
Defining, Evaluating and Distributing Health Care: An Introduction	1	(91)
Defining Sickness	1	(16)
Quality in Health Care	17	(12)
The Problem of Medical Error	29	(36)
Distributive Justice and the Allocation of Health Care Resources---The Example of Human Organ Transplantation	65	(27)
PART I. PROMOTING QUALITY
Quality Control Regulation: Licensing of Health Care Professionals	92	(34)
Discipline	93	(10)
Alternative and Complementary Medicine	103	(5)
Unlicensed Providers	108	(9)
Scope Of Practice Regulation	117	(9)
Quality Control Regulation of Health Care Institutions	126	(36)
Introduction	126	(2)
Regulatory Systems	128	(27)
Private Accreditation Of Health Care Facilities	155	(7)
PART II. ACCESS AND COST CONTROL
Health Care Cost and Access: The Policy Context	162	(33)
The Problems	162	(13)
Approaches to Health Care Reform	175	(20)
Private Health Insurance and Managed Care: State Regulation and Liability	195	(96)
Insurance and Managed Care: Some Basic Concepts	195	(10)
Contract Liability of Private Insurers and Managed Care Organizations	205	(5)
Tort Liability of Managed Care	210	(49)
Regulation of Private Health Insurance Under State Law	259	(7)
State Regulation of Managed Care	266	(21)
Perspectives on Managed Care Regulation	287	(4)
Regulation of Insurance and Managed Care: The Federal Role	291	(79)
Introduction	291	(1)
The Employee Retirement Income Security Act of 1974 (ERISA)	291	(58)
Federal Initiatives to Expand Private Insurance Coverage: The Health Insurance Portability and Accountability Act of 1996, the Consolidated Omnibus Reconciliation Act of 1995 and the Americans With Disabilities Act	349	(21)
Public Health Care Programs: Medicare and Medicaid	370	(71)
Introduction	370	(3)
Medicare	373	(45)
Medicaid	418	(20)
The State Children's Health Insurance Program (Schip)	438	(3)
Access to Health Care: The Obligation to Provide Care	441	(43)
Physicians' Duty to Treat	442	(18)
Hospitals' Duty to Provide Treatment	460	(24)
PART III. ORGANIZING THE HEALTH CARE ENTERPRISE
Professional Relationships in Health Care Enterprises	484	(47)
Staff Privileges and Hospital-Physician Contracts	485	(14)
Managed Care Contracts For Professional Services	499	(6)
Labor and Employment	505	(18)
Discrimination Law	523	(8)
The Structure of the Health Care Enterprise	531	(102)
Introduction: Where's Waldo?---Part I	531	(1)
Forms Of Business Enterprises and Their Legal Consequences	532	(31)
Integration And New Organizational Structures	563	(12)
Tax-Exempt Health Care Organizations	575	(58)
Fraud and Abuse	633	(64)
False Claims	633	(23)
Medicare and Medicaid Fraud and Abuse	656	(27)
The Stark Law: A Transactional Approach To Self-Referrals	683	(9)
State Statutes and Alternative Approaches to Referrals and Fee Splitting	692	(5)
Antitrust	697	(108)
Cartels and Professionalism	702	(41)
Health Care Enterprises, Integration and Financing	743	(62)
Index	805