Monday, July 18, 2005
From the Social Science Research Network's "Health Law & Policy" file:
The Two Faces of Managed Care Regulation & Policymaking
Stanford Law & Policy Review, Vol. 16, p. 234, 2005
Robert Rich and Christopher T. Erb
University of Illinois College of Law and University of Illinois at Urbana-Champaign
ABSTRACT: This paper focuses on the development of managed care policy in the United States since 1985. It empirically examines the development of statutes, legislation, regulations, and federal and state court decisions which relate to managed care organizations and managed care policies. The paper begins with an analysis of managed care theory as it relates to the delivery of health care services in the United States. It then goes on to ask the question: is this a good theory? We then look at federal and state policy initiatives in the executive, legislative, and judicial branches of government. The paper argues that government cannot make up its mind whether it wants to support or constrain the implementation of managed care theory and its further development. We document initiatives which serve as facilitators and barriers to the implementation of managed care theory; taken together, these legal and policy initiatives represent the "two faces of managed care". The consequence of the two faces is that it is not clear whether managed care organizations have been successful.