The Legal Subtext of the Managed Care Environment: A Practitioner's Perspective

See Harvard Medical Practice Study to the State of New York, “Patients, Doctors and Lawyers: Medical Malpractice Litigation and Patient Compensation in New York” (1990).

For a consideration of the ethical issues in managed care, see Biblo J.D. , Ethical Issues in Managed Care Guidelines for Clinicians and Recommendations to Accrediting Organizations (Kansas City: Midwest Bioethics Center, 1995).

Wickline v. California, 228 Cal. Rptr. 661, appeal granted, 231 Cal. Rptr. 560, 727 P.2d 753 (1986).

Bush v. Dake, No. 86–25656 (Mich. Cir. Ct. Apr. 27, 1989).

Boyd v. Einstein, 547 A.2d 1229 (Pa. Super. 1988).

Hand v. Tavera, No. 04-92-00618CV (4th Cir. Sept. 22, 1993).

See, for example, Corcoran v. United Healthcare Inc., 965 F.2d 1321 (5th Cir. 1992).

42 U.S.C. § 1395dd (1993).

See Hand, No. 04-92-00618CV at 5.

See Rolph E. , ed., Health Care Delivery and Tort: Systems on a Collision Course? (Santa Monica: Institute for Civil Justice, RAND Corp., 1992).

For a discussion of the data and performance measurement initiatives underway today, see Gosfield A.G. , “Measuring Performance and Quality: The State of the Art and Legal Concerns,” in Gosfield A.G. , ed., 1995 Health Law Handbook (New York: Clark Boardman Callaghan, 1995): 31–68.

Id. at 33–34.

For a consideration of Medicare issues, see Gosfield A.G. , “Value Purchasing in Medicare Law: Precursor to Health Reform,” American journal of Law & Medicine, XX (1994): 169–86.

National Committee for Quality Assurance, Healthplan Employer Data and Information Set and User's Manual 2.0 (Washington, D.C.: National Committee for Quality Assurance, 1993).

Teti v. U.S. Health Care, No. 88–9808 (E.D. Pa. 1988).

Institute of Medicine, Gray B. Field M.J. , eds., Controlling Costs and Changing Patient Care? The Role of Utilization Management (Washington, D.C.: National Academy Press, 1989): At 154.

But see Biblo , supra note 2, at 13 for an ethical consideration of this issue.

See National Committee for Quality Assurance, supra note 14.

I suppose the determination of “effectiveness of selection” implied here is itself an ethical dilemma, in the sense that the bases for choice are so different that employers and other consumer surrogates simply cannot make this decision for their beneficiaries. This conundrum would have been eliminated in the Clinton proposal, which put the burden of selection on the consumer.

For a full consideration of the issues regarding guidelines, see Gosfield A.G. , “Clinical Practice Guidelines and the Law: Applications and Implications”, in Gosfield A.G. , ed., 1994 Health Law Handbook (New York: Clark Boardman Callaghan, 1994): 65–99.

See Institute of Medicine, Field M.J. Lohr K.N. , eds., Clinical Practice Guidelines: Directions for a New Program (Washington, D.C.: National Academy Press, 1990); and Institute of Medicine, Field M.J. Lohr K.N. , eds., Guidelines for Clinical Practice From Development to Use (Washington, D.C.: National Academy Press, 1992).

See Gosfield A.G. , “Value Purchasing and Effectiveness: Legal Implications”, in Gosfield A.G. , ed., 1991 Health Law Handbook (New York: Clark Boardman, 1991): At 194–99; and Gosfield A.G. , “Utilization Management, Quality Assurance and Practice Guidelines,” in National Health Lawyers Association, 1994 Health Law Practice Guide (New York: Clark Boardman Callaghan, Vol. 2, 1994): At 25–1 to 25–98.

See Corcoran v. United HealthCare Inc., 965 F.2d 1321 (5th Cir. 1992).

See Rothschild I. , “The Health Care Quality Improvement Act and the National Practice Forum Data Bank: Current Issues and Emerging Legal and Operational Trends,” in Gosfield A.G. , ed., 1993 Health Law Handbook (New York: Clark Boardman Callaghan, 1993): 313–62.

42 U.S.C. § 1395nn (Supp. 1994) and 42 U.S.C. § 1320a-7 (1988).