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Related Experiment Videos

Expanded managed care liability: what impact on employer coverage?

D M Studdert1, W M Sage, C R Gresenz

  • 1Columbia University, USA.

Health Affairs (Project Hope)
|January 29, 2000
PubMed
Summary

Increased civil liability for managed care organizations may alter health coverage decisions and employer involvement, despite uncertain direct costs. The study analyzes potential impacts on health plans and ERISA plan sponsors facing new litigation risks.

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Area of Science:

  • Health Policy
  • Law and Economics
  • Healthcare Management

Background:

  • Policymakers are exploring legislative changes to increase civil liability for managed care organizations.
  • This potential legislation targets organizations that withhold coverage or fail to provide necessary medical care.

Purpose of the Study:

  • To assess health plan and Employee Retirement Income Security Act (ERISA) plan sponsor responses to expanded civil liability.
  • To evaluate the policy implications of these potential responses.

Main Methods:

  • The study employs a combination of empirical data and theoretical analysis.
  • It examines the likely reactions of health plans and ERISA plan sponsors to increased litigation exposure.

Main Results:

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  • Direct financial costs associated with expanded liability remain uncertain.
  • The anticipation of litigation may significantly influence coverage decisions.
  • Potential impacts include changes in information exchange, risk contracting, and employer engagement in health coverage.

Conclusions:

  • Expanded civil liability for managed care organizations could indirectly reshape healthcare delivery and coverage.
  • The effects extend beyond direct costs, influencing strategic decisions within health plans and employer-sponsored plans.
  • Further analysis is needed to fully understand the complex interplay between liability, coverage, and employer involvement.