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Related Experiment Videos

Reining in the HMOs.

M W Serafini

    National Journal
    |September 29, 1996
    PubMed
    Summary

    States and Congress are enacting laws to protect patients within managed health care systems. While managed care plans accept some changes, they express concerns about excessive regulation impacting their operations.

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    Area of Science:

    • Health Law
    • Public Health Policy
    • Managed Care Regulation

    Background:

    • The expansion of managed health care necessitates patient protections.
    • State legislatures are actively creating new laws governing managed care.
    • Federal legislative bodies are also addressing managed care oversight.

    Purpose of the Study:

    • To examine the evolving legal landscape of managed health care.
    • To understand the impact of state and federal legislation on patient access and information.
    • To assess the managed care industry's response to increased regulation.

    Main Methods:

    • Review of state statutes and federal legislation concerning managed care.
    • Analysis of policy documents and industry statements.
    • Comparative legal analysis of patient protection laws.

    Main Results:

    • A growing number of state laws mandate patient access to specialists and treatment details.
    • Congressional actions are mirroring state efforts to regulate managed care.
    • Managed care organizations are adapting to new regulations but voice concerns regarding over-regulation.

    Conclusions:

    • The proliferation of managed care is driving significant legislative and regulatory changes.
    • Patient advocacy is a key factor influencing the direction of managed care laws.
    • Balancing patient protection with industry viability remains a critical challenge in managed care policy.

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