Regulating Managed Care: Theory, Practice and Future Options

Edited by Stuart H. Altman, Uwe E. Reinhardt and David Shactman

In today's market-driven health care system, issues such as consumer choice, access to specialists, denials of coverage, and "drive-through" methods of care delivery have been thrust to the forefront of the managed care debate. Wanting nothing more than to create a managed care system that is accessible and affordable—to all Americans— policy makers, clinicians, and consumers are working to find the right balance between competition and regulation that will insure a high quality and compassionate health care system. But regulating markets is no easy task, and individuals-even those with similar objectives-differ on the major questions to be resolved. Can managed care be effectively regulated?

Led by Stuart Altman, Uwe Reinhardt, and David Shactman, Regulating Managed Care brings together twenty-six of the foremost health policy experts, offering the rare opportunity to listen in while they debate this critical social issue. These influential contributors-including managed competition's architect, Alain Enthoven-provide leaders essential background on the critical issues, summarize key survey findings on how Americans feel about managed care, assess what areas are thought to need regulation, and examine the effect of proposed regulation on health care access, cost, and quality.

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Table of Contents

Foreward
Steven A. Schroeder

INTRODUCTION: THE PHILOSPHY OF REGULATION
Stuart H. Altman and Brian Rosman

SECTION I: THE ROLE OF REGULATION IN A MARKET ORIENTED HEALTH CARE SYSTEM

Chapter 1: Regulating Managed Care: An Overview
Walter Zelman

Chapter 2: The Current Status of State and Federal Regulation
Patricia Butler

Chapter 3: Why Should Managed Care Be Regulated?
Mark Pauly and Marc Berger

Chapter 4: Macro Versus Micro Regulation
Thomas Rice

SECTION II: REGULATORY ISSUES

Chapter 5: Consumer Choice Under Private Health Care Regulation
Uwe E. Reinhardt

Chapter 6: The Long-Term Care Ombudsman Program: A Model for Health Care Consumers
William Benson

Chapter 7: Ensuring Equal Access to Care
Brian Biles and David Sandman

Chapter 8: Regulating Quality and Clinical Practice
William L. Roper

Chapter 9: Managed Care Liability
David Keepnews

Chapter 10: ERISA, and the Regulation of Group Health Plans
Craig Copeland and Bill Pierron

SECTION III: PERSPECTIVES ON REGULATION

Chapter 11: The Public: Understanding the Managed Care Backlash
Robert J. Blendon et al

Chapter 12: A Foundation Perspective: Insuring Health Care Quality Through Regulation
Karen Davis and David Sandman

Chapter 13: The Managed Care Industry: Balancing Market Forces and Regulation
Karen Ignagni

Chapter 14: Regulation from a Consumer's Perspective
Ronald F. Pollack

Chapter 15: Regulation from an Insurance Industry Perspective
William Gradison

Chapter 16: Regulation Misses the Big Issue: The Uninsured
Larry S. Gage

SECTION IV: MANAGED CARE REGULATION IN PRACTICE

Chapter 17: Creating Standards: A Practical Approach
Phil Nudelman

Chapter 18: California's Struggle with Regulation
Sara J. Singer and Alain C. Enthoven

Chapter 19: The Cost of Regulation: How the Estimates Vary
Allen Dobson and Caroline Steinberg