Regulating Managed Care: Theory, Practice, and Future Options

What should be government's role in a market-oriented health caresystem? What's the appropriate amount of regulation? Who should regulate-states, federal government, or marketforces? What role do the courts play in this regulation? Are there existing models that might guide leaders in designing aneffective regulatory structure? Welcome to the great managed care debate. In Regulating ManagedCare, twenty-six of the nation's leading health policy experts givehealth care administrators, clinicians, and policy makers insightinto the issues behind this critical exchange and provide leaderswith a road map to assess the policy options available to protectthe quality of our health care delivery system. "This collection of papers, from an extraordinary group of authors,makes a valuable contribution to the ongoing policy debate and willbe of interest to anyone concerned with the future of our healthcare system."---Charles A. Sanders, retired chairman and CEO GlaxoInc. and former general director, Massachusetts General Hospital

Table of Contents:
Foreword (Steven A. Schroeder). Acknowledgments. The Editors. The Contributors. Introduction: The Philosophy of Regulation. Section I: The Role of Regulation in a Market-Oriented Health CareSystem. 1. Regulating Managed Care: An Overview (Walter Zelman). 2. The Current Status of State and Federal Regulation (PatriciaButler). 3. Why Should Managed Care Be Regulated? (Mark Pauly and Marc L.Berger). 4. Macro- Versus Microregulation (Thomas Rice). Section II: Regulatory Issues. 5. Consumer Choice Under "Private Health Care Regulation" (Uwe E.Reinhardt). 6. The Long-Term Care Ombudsman Program: A Model for Health CareConsumers (William F. Benson). 7. Ensuring Equal Access to Care (Brian Biles and DavidSandman). 8. Regulating Quality and Clinical Practice (William L.Roper). 9. The Scope of Managed Care Liability (David M. Keepnews). 10. ERISA and the Regulation of Group Health Plans (Craig Copelandand William L. Pierron). Section III: Perspectives on Regulation. 11. The Public: Understanding the Managed Care Backlash (Robert J.Blendon, Mollyann Brodie, John M. Benson, Drew E. Altman, LarryLevitt, Tina Hoff, and Larry Hugick). 12. A Foundation Perspective: Core Principles for Regulating HealthCare Quality (Karen Davis and David Sandman). 13. The Managed Care Industry: Balancing Market Forces andRegulation (Karen Ignagni). 14. Regulation from a Consumer's Perspective (Ronald F.Pollack). 15. Regulation from an Insurance Industry Perspective (BillGradison). 16. Regulation Misses the Big Issue--The Uninsured (Larry S.Gage). Section IV: Managed Care Regulation in Practice. 17. Creating Standards: A Practical Approach (Phil Nudelman). 18. California's Struggle with Regulation (Sara J. Singer and AlainC. Enthoven). 9. The Cost of Regulation: How the Estimates Vary (Allen Dobson andCaroline Steinberg).

About the Author :
STUART H. ALTMAN is the Sol C. Chaikin Professor of National Health Policy and chair, Council on the Economic Impact of Health System Change, Institute for Health Policy, Heller Graduate School, Brandeis University. He has held key health policy offices for Presidents Carter, Reagan, Bush, and Clinton. UWE E. REINHARDT is James Madison Professor of Political Economy, Princeton University. He is regularly quoted in the New York Times, Wall Street Journal, Health Affairs, and other publications. DAVID SHACTMAN is project director, Council on the Economic Impact of Health System Change, Institute for Health Policy, Heller Graduate School, Brandeis University.

Review :
"This is a very useful collection of essays by some of the nation'smost influential health policy experts. Topics covered: the theoryof regulation, the ways in which the HMO industry does and does notfit the standard model, and consumer and insurance industryperspectives on regulation and practical implementation issues."(Bryan E. Dowd, University of Minnesota School of Public Health,Hospital & Health Networks, March 2000) "This collection of papers, from an extraordinary group of authors,makes a valuable contribution to the ongoing policy debate and willbe of interest to anyone concerned with the future of our healthcare system." (Charles A. Sanders, retired chairman and CEO, GlaxoInc., and former general director, Massachusetts GeneralHospital) "This balanced collection of cutting-edge papers reviewing thetheory and practice of health regulation is a must-read for thosewho regulate and for those regulated by this market-moving thedebate from whether to regulate to how to do this most difficulttask more effectively." (W. David Helms, CEO, Association forHealth Services Research and president, Alpha Center)