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Managed Care Takes to the Highway: Implications for Insureds
Published online by Cambridge University Press: 01 January 2021
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Automobile insurance companies are joining the move to managed care in the hopes of reducing health-care expenditures arising out of automobile accidents. Industry interest is strong enough that large managed care organizations, such as Concentra Managed Care, Inc., and HNC Insurance Solutions, are beginning to offer their existing network of providers to persons seeking medical care for automobile accident injuries and their evaluation software to insurers.
While insurance companies have successfully pressed four state legislatures and one commissioner of insurance for authorization to offer consumers a managed care option in automobile insurance policies, these efforts have not gone unchallenged. Vocal opponents, primarily lawyer and chiropractic organizations, question whether persons injured in accidents will receive care when needed (especially if the accident occurs when the policyholder is away from home), what the quality of care received will be, and whether any savings will be passed on to consumers.
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References
“Concentra Managed Care, Inc., Commits to Expanded Resources in Managed Care,” Business Wire, April 8, 1998, LEXIS, Nexis Library, Business Wire file.Google Scholar
“HNC Insurance Solutions to Offer CCN's Auto Provider Network Through Its AUTOADVISOR Product,” Business Wire, February 24, 2000, LEXIS, Nexis Library, Business Wire file.Google Scholar
“Car Insurers Use Managed Care to Cut Medical Claims,” BestWire, December 14, 1993, LEXIS, Nexis Library, BestWire file.Google Scholar
Cox, B., “Managed Care in Auto Policies Attacked by N.J. Trial Lawyers,” National Underwriter (Life, Health/Financial Services edition), October 2, 1995, at 37.Google Scholar
See “Insurers and Attorneys Clash Over Managed Care for Auto Policies,” BestWire, January 3, 1994, LEXIS, Nexis Library, BestWire file.Google Scholar
As more fully explained in notes 9 and 10, in a no-fault monetary threshold state, a managed care system may result in fewer injured persons incurring costs above the threshold needed for a liability claim. See “American Insurance Association Says MA Commission Has Clear Authority to Approve Cost-Saving Auto Managed Care Option for Consumers,” PR Newswire, March 6, 1997, LEXIS, Nexis Library, PR Newswire file.Google Scholar
See Mass. Gen. Laws Ann. ch. 175, § 2 (West 2000).Google Scholar
See N.J. Stat. Ann. § 39:6A-4(a) (West 2000).Google Scholar
According to the Insurance Research Council, twenty-seven states are in this category. Insurance Research Council, Trends in Auto Injury Claims (Malvern, Pennsylvania: Insurance Research Council, 2000): at 718 n.2.Google Scholar
Thirteen states have no-fault laws. Id. According to the Insurance Research Council, the frequency of lawyer involvement in automobile accident claims fell by 2 percent in 1998. The Council also found that claimants with lawyers received less than claimants without lawyers once legal fees and other costs were deducted, and that they waited longer to receive compensation. Insurance Research Council, Paying for Auto Injuries (Malvern, Pennsylvania: Insurance Research Council, 1999): at 45–60.Google Scholar
See Insurance Research Council, Trends in Auto Injury Claims, supra note 9. In Massachusetts, as an example of a monetary threshold, a claim for damages from an automobile accident is only possible if the medical costs for treating the injury exceed $2,000. Mass. Gen. Laws Ann. ch. 231 § 6D (West 2000). Michigan is an example of a severity threshold, allowing a claim for “tort liability for non-economic loss … only if the injured person has suffered death, serious impairment of body function, or permanent serious disfigurement.” Mich. Comp. Laws Ann. § 500.3135 (West 2000).Google Scholar
Ten states and the District of Columbia have chosen this approach. Insurance Research Council, Trends in Auto Injury Claims, supra note 9.Google Scholar
See id. at n.1.Google Scholar
Russ, L.R., ed., “Introduction to Automobile Liability Insurance,” Couch on Insurance 3d (St. Paul, Minnesota: West, 1998): At 158–63.Google Scholar
Colo. Rev. Stat. Ann. § 10–4–706 (West 2000). PIP in Colorado also includes loss of wages for fifty-two weeks up to $400 per week, essential services for fifty-two weeks up to $25 per day, and a $1,000 death benefit.Google Scholar
Haw. Rev. Stat. § 431:10C-103.5(c) (2000).Google Scholar
Fla. Stat. Ann. § 627.736(4) (West 2000).Google Scholar
Mass. Gen. Laws. Ann. ch. 90 § 34A (West 2000).Google Scholar
There may be factual disputes in a particular situation over whether or not a preexisting condition reduces or precludes PIP coverage (see Faulkner v. Allstate Life Ins. Co., 684 N.E.2d 155 (Ill. App. Ct. 1997)), there may be statutory issues over whether “stacking” of coverage is allowed (see Frigo v. Motors Ins. Corp., 648 N.E.2d 180 (Ill. App. Ct. 1995)). Both of these topics are beyond the scope of this article, however.Google Scholar
See Colo. Rev. Stat. Ann. § 10–4-709(1) (West 2000).Google Scholar
See Fla. Stat. Ann. § 627.736(4) (West 2000).Google Scholar
Mich. Comp. Laws Ann. § 500.3109a (West 2000).Google Scholar
In Massachusetts, an injured person whose group health insurance is through an HMO or other managed care format must use his or her own managed care provider after the first $2,000 in health-care costs. Mass. Gen. Laws Ann. ch. 90 § 34A (West 2000).Google Scholar
Colorado Auto Accident Reparations Act, Colo. Rev. Stat. Ann. § 10-4-701 to § 10-4-723, and, specifically, § 10–4-706(2)(a) (West 2000).Google Scholar
Cox, B., “Colorado Auto Insurers Cite Managed Care Gains,” National Underwriter (Property & Casualty/Risk & Benefits Management edition), August 14, 1995, at 6.Google Scholar
Fla. Stat. Ann. § 627.736(10) (West 2000).Google Scholar
Adams, M., “Florida,” National Underwriter (Property & Casualty/Risk & Benefit Management edition), January 1, 1996, at 4.Google Scholar
Fla. Stat. Ann. § 627.736(10) (West 2000).Google Scholar
Haw. Rev. Stat. § 431:10C–302.5 (2000).Google Scholar
N.J. Stat. Ann. § 39:6A–4 (West 2000).Google Scholar
Subchapter 4 Personal Injury Protection Benefits; Medical Protocols; Diagnostic Tests, N.J. Admin. Code tit. 11 §§ 3–4 (2000).Google Scholar
N.J. Stat. Ann. § 39:6A–4 (West 2000).Google Scholar
Reich-Hale, D., “N.J. Upholds Medical Protocols in Auto Reform,” National Underwriter (Property & Casualty/Risk & Benefits Management edition), November 22, 1999, at 30.Google Scholar
Diamond, R., “Year After Reform, Car Insurance Rates Lower,” The Record (Bergen County, N.J.), March 22, 2000, at A1.Google Scholar
See “First MA Auto Insurer to Add ‘Managed Care’ Clause to Policy,” Andrews Insurance Coverage Litigation Report, January 23, 1998, at 76.Google Scholar
“Auto Managed Care at Bat in Bay State,” Insurance Regulator, September 2, 1996, at 4, LEXIS, Nexis Library, Insurance Regulator file.Google Scholar
“Mass. Auto Insurer Seeks HMO Discount,” BestWre, March 2, 2000, LEXIS, Nexis Library, BestWire file.Google Scholar
Mohl, B., “Auto Insurer Again Seeks HMO Discount,” Boston Globe, March 1, 2000, at C6.Google Scholar
Baker, T., Minnesota Department of Commerce, telephone conversation with L. Wolff (June 8, 2000).Google Scholar
Nakhgevany, K.B., LiBassi, M., and Esposito, B., “Facial Trauma in Motor Vehicle Accidents: Etiological Factors,” American Journal of Emergency Medicine, 12(1994): 160–63.Google Scholar
U.S. Census Bureau, “No. 1041 Motor Vehicle Accidents —Number and Deaths: 1972 to 1997,” Statistical Abstracts of the United States: 1999 (Washington, D.C.: Government Printing Office, 1999): At 645Google Scholar
Of those injured in automobile accidents, 52 percent reported neck sprain or strain, and 44 percent reported back sprain or strain. In addition, 49 percent reported the sprain or strain as the most serious injury suffered, and 48 percent reported no disability from the injury. Id. at 11.Google Scholar
See id. at 33. In a year-long study of 479 trauma patients, 55 percent of whom were injured in an automobile accident, the researchers found that the two most important types of injuries with regard to disability and cost were moderate to severe injury to the brain and spine. Severe abdominal and thoracic injuries had good outcomes but very high costs of care. Of the patients with minor head injuries, 75 percent returned to work within one year. Only 63 percent of patients with minor extremity injuries and 54 percent with moderate injuries returned to full-time work within one year. “Our results suggest that injuries to extremities, especially those to the lower extremities and pelvis, are associated with significant disability and very high inpatient costs due to long hospital stays.” Mackenzie, E.J. et al., “Functional Recovery and Medical Costs of Trauma: An Analysis by Type and Severity of Injury,” Journal of Trauma, 28 (1988): 281–97.Google Scholar
Campbell, A.R. et al., “Trauma Centers in a Managed Care Environment,” Journal of Trauma, 39 (1995): 246–53.Google Scholar
Reath, D.B. et al., “Injury and Cost Comparison of Restrained and Unrestrained Motor Vehicle Crash Victims,” Journal of Trauma, 29 (1989): 1173–77.Google Scholar
Redelmeier, D.A., Blair, P.J., “Survivors of Motor Vehicle Trauma,” Journal of General Internal Medicine, 8 (1993): 199–203. These researchers also noted that although belted drivers had more outpatient visits in the year following injury, their total medical costs were still much less expensive.Google Scholar
As noted by Roger Feldman, the question is no longer whether managed care is effective in controlling costs, but rather whether it has gone too far. Feldman, R., “The Ability of Managed Care to Control Health Care Costs: How Much Is Enough?,” Journal of Health Care Finance, 26, no. 3 (2000): 15–25. See also Enthoven, A.C. and Singer, S.J., “The Managed Care Backlash and the Task Force in California,” Health Affairs, 17, no. 4 (1998): 95–110; Zwanziger, J. and Melnick, G.A., “Can Managed Care Plans Control Health Care Costs?,” Health Affairs, 15, no. 2 (1996): 185–99.Google Scholar
A Rand study analyzed a national sample of automobile accident injury claims that were closed in 1987. By comparing the ratio of soft-tissue injuries to hard-tissue injuries, it was concluded that in traditional tort states, an estimated 55 percent of soft-tissue claims were false or exaggerated. No-fault states with monetary thresholds were next with a rate of 30 to 40 percent. These results indicated that both traditional tort systems and monetary threshold systems provided incentives for persons to submit claims for nonexistent injuries. Abrahams, A.F. and Carroll, S.J., The Frequency of Excess Claims for Automobile Personal Injuries (Santa Monica, California: Rand/RP-810, 1999).Google Scholar
Press Release, Casualty Actuarial Society, “Use of Managed Care in Workers Comp and Auto Has Ratemaking Implications” (March 13, 1997), available at <http://www.casact.org/aboutcas/press/mancare.htm>..>Google Scholar
Jackson, P., “Medical Costs Driving Auto Claim Growth,” National Underwriter (Property & Casualty/Risk Benefits Management edition), May 4, 1988, at 16–17.Google Scholar
Insurance Information Institute, “Controlling Medical Care Costs in Property/Casualty Insurance,” available at <http://www.iii.org/media/hottopics/insurance/medicalcare>..>Google Scholar
Turpin, T. and Lee, D., “An Analysis of the Minnesota Private Passenger Automobile No-Fault System,” William Mitchell Law Review, 24 (1998): 1019–43.Google Scholar
In Massachusetts, where the dollar threshold is only $2,000, 52 percent of PIP claimants were eligible to pursue liability claims in 1997. In Michigan, which has a severity threshold, only 15 percent of claimants were eligible to pursue additional compensation. See Insurance Information Institute, Trends in Auto Injury Claims, supra note 9, at n.5, n.6.Google Scholar
See Redelmeier, and Blair, supra note 52. The exception is young male drivers who have the highest level of injuries from automobile accidents and the lowest level of seat belt use. See Reath, et al., supra note 51.Google Scholar
In a study by Orsay and colleagues, of those patients most severely injured in an automobile accident, 81.8 percent were not wearing a seat belt at the time of the accident. Orsay, E.M. et al., “Prospective Study of the Effect of Safety Belts on Morbidity and Health Care Costs in Motor-Vehicle Accidents,” JAMA, 260 (1988): 3598–603. Redelmeier, and Blair, supra note 52, found that seat belts reduce the risk of life-threatening injuries by 75 percent. Of the 461 patients included in a study by Nakhgevany et al., supra note 45, who were admitted to a trauma center after an automobile accident, 51 percent had facial injuries (as well as head and thoracic injuries). Of these 51 percent, 82 percent were not wearing a seat belt at the time of the accident. See also Lestina, D.C. et al., “Motor Vehicle Crash Injury Patterns and the Virginia Seat Belt Law,” JAMA, 265 (1991): 1409–13. Unrestrained passengers in the back seat are also at higher risk for serious injury. Christian, M.S., “Non-Fatal Injuries Sustained by Back Seat Passengers,” British Medical Journal, i (1975): 302–22.Google Scholar
See Hyman, D.A., “Consumer Protection(?), Managed Care, and the Emergency Department,” in Blum, J.D., ed., Achieving Quality in Managed Care: The Role of Law (Chicago, Illinois: American Bar Association, Health Law Section, 1997): 57–77, at 59.Google Scholar
Comstock, B., legal analyst for State Farm, telephone conversation with B. Purcell (April 2000).Google Scholar
Shortell, S.M. et al., “The Relationships Among Dimensions of Health Services in Two Provider Systems: A Causal Model Approach,” Journal of Health & Social Behavior, 18 (1977): 139–59.Google Scholar
Manning, W.G. et al., “Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment,” American Economic Review, 77 (1987): 251–77. See also Manning, W.G. et al., “A Controlled Trial of the Effect of a Prepaid Group Practice on Use of Services,” N. Engl. J. Med., 310 (1984): 1505–10.Google Scholar
See Clement, D.G. et al., “Access and Outcomes of Elderly Patients Enrolled in Managed Care,” JAMA, 271 (1994): 1487–92.Google Scholar
See Krieger, J.W., Connell, F.A., and LoGerfo, J.P., “Medicaid Prenatal Care: A Comparison of Use and Outcomes in Fee-for-Service and Managed Care,” American Journal of Public Health, 82 (1992): 185–90.Google Scholar
See Ker, H.D., “Access to Emergency Departments: A Survey of HMO Policies,” Annals of Emergency Medicine, 18 (1989):274–77.Google Scholar
See Wolinsky, F.D. and Marder, W.D., “Waiting to See the Doctor: The Impact of Organizational Structure on Medical Practice,” Medical Care, 21 (1983): 531–42.Google Scholar
See Kramer, A.M. et al., “Outcomes and Costs After Hip Fracture and Stroke: A Comparison of Rehabilitation Settings,” JAMA, 277 (1997): 396–404.Google Scholar
Basic economic theory predicts that the demand for health care (or any other normal product) will increase as the price falls and vice versa. Having insurance reduces the price for the consumer of medical services. The term “moral hazard” “suggests that individuals ‘shirk’ their responsibilities and consume recklessly when they are insured.” Jacobs, P., The Economics of Health and Medical Care, 3rd edition (Gathersburg, Maryland: Aspen Publishers, 1991): At 107–9.Google Scholar
David Hyman asserts that unnecessary emergency room visits are an expensive drain on resources, estimating the excess annual costs to be $5 billion to $14 billion. Hyman, supra note 65. However, not everyone agrees with the commonly held belief that the misuse of emergency room services for the treatment of illnesses that could be handled in a physician's office or medical clinic is a large source of excess health-care costs. See Tyrance, P.H., Himmelstein, D.U., and Woolhandler, S., “U.S. Emergency Department Costs: No Emergency,” American Journal of Public Health, 86 (1996): 1527–31.Google Scholar
For a comprehensive analysis of managed care cost containment, see Kongstvedt, P.R., Essentials of Managed Health Care (Gathersburg, Maryland: Aspen Publishers, 1995).Google Scholar
Luft, H.S., Health Maintenance Organizations: Dimensions of Performance (New Brunswick, New Jersey: Transaction Books, 1987).Google Scholar
Miller, R.H. and Luft, H.S., “Managed Care Performance Since 1980: A Literature Analysis,” JAMA, 217 (1994): 1512–19;. Miller, R.H. and Luft, H.S., “Does Managed Care Lead to Better or Worse Quality of Care?,” Health Affairs, 16, no. 5 (1997): 7–25.Google Scholar
Jon Gabel identified ten ways in which HMOs did not just grow, but “changed substantially” in the 1990s. These included: “(1) the rapid growth of for-profit HMOs; (2) the rapid growth of network and individual practice association (IPA) models; (3) the growth of mixed-model HMOs; (4) product diversification; (5) industry consolidation; (6) the decline of community-rating methods; (7) altered payment arrangements with physicians; (8) increased patient cost sharing; (9) declining hospital use; and (10) increased use of clinical guidelines.” Gabel, J., “Ten Ways HMOs Have Changed During the 1990s,” Health Affairs, 16, no. 3 (1997): 134–45.Google Scholar
See Reschovsky, J.D., Kemper, P., and Tu, J., “Does Type of Health Insurance Affect Health Care Use and Assessments of Care Among the Privately Insured?,” Health Services Research, 35 (2000): 219–37.Google Scholar
Utilization was further subdivided into hospital admission rates, hospital length of stay, hospital days per enrollee, physician visits per enrollee, and use of services that are expensive and/or have less costly alternatives. See id.Google Scholar
This section was further subdivided into hospital charges per stay, hospital expenditures per enrollee, physician/outpatient charges or expenditures per enrollee, total expenditures per enrollee, impact of HMO market penetration on hospital costs, premium levels, and rate of premium growth. See id.Google Scholar
Colorado's law specifically mentions HMOs and PPOs. See Colo. Rev. Stat. Ann. § 10–4-706(2) (West 2000). Florida uses the term “preferred provider.” See Fla. Stat. Ann. § 627.736(10) (West 2000).Google Scholar
Miller, and Luft, (1997), supra note 78. Resource use was further subdivided into hospital utilization, more costly tests and procedures, physician visits and outpatient spending, home health care, total spending, and premiums.Google Scholar
Enrollee satisfaction was further subdivided into overall satisfaction, financial aspects, and non-financial aspects. See id.Google Scholar
A recent series of articles in the Winter 1999/2000 issue of Inquiry attempted to overcome some of these limitations. Several of these articles have been included in this review. See infra notes 109, 110, 118, and 137.Google Scholar
A survey, mailed to 180,000 households, asked if anyone in the household had been in a motor vehicle accident in the past three years. A total of 129,498 questionnaires were returned, and 23.4 percent reported an automobile accident. Of these, 8,511 also reported a personal injury. This subgroup was then screened, and 7,209 were sent a second questionnaire that requested additional details. Of these households, 4,751 returned the second survey, and the final data set included 5,768 injured persons. Insurance Research Council, Paying for Auto Injuries, supra note 10, at 2–3.Google Scholar
Of those reporting sprains or strains, 49 percent listed this as the most serious injury from the accident. Id. at 11.Google Scholar
American College of Emergency Physicians, “Managed Health Care Plans and Emergency Care,” Annals of Emergency Medicine, 17 (1988): 97–98.Google Scholar
Johnson, L.A. and Derlet, R.W., “Conflicts Between Managed Care Organizations and Emergency Departments in California,” Western Journal of Medicine, 164 (1996): 137–42. The Emergency Medical Treatment and Labor Act (EMTALA), 42 U.S.C. § 1395dd (1992), requires the emergency department of any hospital receiving Medicare funds to screen anyone seeking medical services to determine whether emergency care is required.Google Scholar
McCormick, B., “Surgeons: Managed Care Traumatic for EDs,” American Medical News, November 14, 1994, at 1–4.Google Scholar
See Hyman, supra note 65. Diane Hoffmann, on the other hand, suggested that “the extent of [emergency department] misuse is questionable.” Hoffmann, D.E., “Emergency Care and Managed Care — A Dangerous Combination,” Washington Law Review, 72 (1997): 315–407, at 348Google Scholar
Johnson, and Derlet, , supra note 93. These authors also noted that managed care organizations were reducing emergency room utilization by both training paramedics in first-aid to preclude the need for a trip to the hospital as well as requiring emergency room personnel to get “treatment authorization.”.Google Scholar
Colo. Rev. Stat. Ann. § 10–4-706(2)(a) (West 2000). Haw. Rev. Stat. 431:10C-302(a)(9)(C) (2000).Google Scholar
N.J. Stat. Ann. § 39:6A-4(a) (West 2000).Google Scholar
See “Concentra Managed Care, Inc., Commits to Expand Resources in Managed Care,” supra note 1. State Farm's policy for Colorado includes a separate sheet describing the no-fault coverage options. In a paragraph explaining a penalty for obtaining care from a non-PPO provider, the policy states that this “penalty does not apply during the first twenty-four hours in which emergency treatment is provided or until the insured patient's emergency medical condition is stabilized.” Colorado Policy Form 9806.5 (Greeley, Colorado: State Farm Mutual Automobile Insurance Company, 1993).Google Scholar
Nine out of ten people reporting a motor vehicle accident injury in the Insurance Research Council study incurred medical expenses. The average payment was $8,912, although this figure is significantly skewed by the 6 percent of patients with losses in excess of $25,000. See Insurance Research Council, Paying for Auto Injuries, supra note 10.Google Scholar
Florida's law does not specifically provide emergency care protection for managed care automobile insurance. See Fla. Stat. Ann. § 627.736 (West 2000).Google Scholar
Furrow, B.R., “Managed Care Organizations and Patient Injury: Rethinking Liability,” Georgia Law Review, 31 (1997): 419–509, at 482.Google Scholar
Waller, J.A., Skelly, J.M., and Davis, J.H., “Emergency Department Care and Hospitalization as Predictors of Disability,” Journal of Trauma, 39 (1995): 632–34.Google Scholar
Tu, H.T., Kemper, P., and Wong, H.J., “Do HMOs Make a Difference? Use of Health Services,” Inquiry, 36 (1999/2000):400–10.Google Scholar
Friedman, B. and Steiner, C., “Does Managed Care Affect the Supply and Use of ICU Services?” Inquiry, 36 (1999):68–77.Google Scholar
Concentra Managed Care, for example, has a network of approximately 25,000 providers in three states. See “Concentra Managed Care, Inc., Commits to Expanded Resources in Managed Care,” supra note 1.Google Scholar
Rubin, H.R. et al., “Patient Ratings of Outpatient Visits in Different Practice Settings,” JAMA, 270 (1993): 835–40.Google Scholar
Mark, T. and Mueller, C., “Access to Care in HMOs and Traditional Insurance Plans,” Health Affairs, 15, no. 4 (1996):81–87.CrossRefGoogle Scholar
Reschovsky, J.D., “Do HMOs Make a Difference? Access to Health Care,” Inquiry, 36 (1999/2000): 390–99.Google Scholar
See “Concentra Managed Care, Inc., Commits to Expand Resources in Managed Care,” supra note 1. “Concentra,” available at <http://www.concentramc.com/basics.htm>..>Google Scholar
In the Insurance Research Council study, 73 percent of payments received for medical costs arising out of automobile accidents were paid by automobile insurance. For persons with less than $1,000 in losses, this percentage increased to 88 percent. For persons with losses in excess of $100,000, automobile insurance paid only 51 percent. Insurance Research Council, Paying for Auto Injuries, supra note 10, at 37–38.Google Scholar
According to the Insurance Research Council study, of those injured, 14 percent reported permanent partial disability, while 2 percent reported permanent total disability. Id. at 15–18.Google Scholar
Safran, D.G., Tarlov, A.R., and Rogers, W.H., “Primary Care Performance in Fee-for-Service and Prepaid Health Care Systems,” JAMA, 271 (1994): 1579–86. This study was limited to patients with hypertension, diabetes, congestive heart failure, recent myocardial infarction, or major depressive disorder. The researchers also pointed out that patients in the fee-for-service arrangements tended to be older and sicker.Google Scholar
Ware, J.E. et al., “Differences in 4-Year Health Outcomes for Elderly Poor, Chronically Ill Patients Treated in HMO and Fee-for-Service Systems: Results from the Medical Outcomes Study,” JAMA, 276 (1996): 1039–47.Google Scholar
Gold, M. et al., “Disabled Medicare Beneficiaries in HMOs,” Health Affairs, 16, no. 5 (1997): 149–62.Google Scholar
Retchin, S.M. et al., “Outcomes of Stroke Patients in Medicare Fee for Service and Managed Care,” JAMA, 278 (1997):119–24.Google Scholar
Webster, J.R. and Feinglass, J., “Stroke Patients, ‘Managed Care,’ and Distributive Justice,” JAMA, 278 (1997): 161–62.Google Scholar
Shaunessy, P.W., Schlenker, R.E., and Hittle, D.F., “Home Health Care Outcomes Under Capitated and Fee-for-service Payment,” Health Care Financing Review, 16, no. 1 (1994): 187–222. These researchers had hypothesized that the management and integration of services offered by managed care would result in better outcomes for home health patients.Google Scholar
Enrollment has increased over the past ten years to its current level of four million enrollees, with most of the increase occurring after 1994. Lamphere, J.A. et al., “The Surge in Medicare Managed Care: An Update,” Health Affairs, 16, no. 3 (1997):127–33.Google Scholar
Riley, G.F., Ingber, M.J., and Tudor, C.G., “Disenrollment of Medicare Beneficiaries From HMOs,” Health Affairs, 16, no. 5 (1997): 117–24.CrossRefGoogle Scholar
Morgan, R.O. et al., “The Medicare-HMO Revolving Door —The Healthy Go In and the Sick Go Out,” N. Engl. J. Med., 337 (1997): 169–75.Google Scholar
The Balanced Budget Act of 1997 limits plan switching to once each enrollment period. 42 U.S.C. § 1395w-21(e)(2) (1997).Google Scholar
Davis, K. et al., “Choice Matters: Employees' Views of Their Health Plans,” Health Affairs, 14, no. 2 (Summer, 1995):99–112.Google Scholar
Ullman, R. et al., “Satisfaction and Choice: A View from the Plans,” Health Affairs, 16, no. 3 (1997): 209–17.CrossRefGoogle Scholar
Druss, B.G. et al., “Chronic Illness and Plan Satisfaction Under Managed Care,” Health Affairs, 19, no. 1 (2000): 203–9.Google Scholar
Lake, T., “Do HMOs Make a Difference? Consumer Assessment of Health Care,” Inquiry, 36 (1999/2000): 411–38.Google Scholar
Blendon, R.J. et al., “Understanding the Managed Care Backlash,” Health Affairs, 17, no. 4 (1998): 80–94.CrossRefGoogle Scholar
Green-McKenzie, J., Parkerson, J., Bernacki, E., “Comparison of Workers' Compensation Costs for Two Cohorts of Injured Workers Before and After the Introduction of Managed Care,” Journal of Occupational and Environmental Medicine, 40 (1998): 568–72.Google Scholar
Dembe, A.E., “Evaluating the Impact of Managed Health Care in Workers' Compensation,” Occupational Medicine: State of the Arts Reviews, 13 (1998): 799–821.Google Scholar
Cheadle, A. et al., “Evaluation of the Washington State Workers' Compensation Managed Care Pilot Project II,” Medical Care, 37 (1999): 982–93.CrossRefGoogle Scholar
Wickizer, T.M., Lessier, D., and Franklin, G., “Controlling Workers' Compensation Medical Care Use and Costs Through Utilization Management,” Journal of Occupational and Environmental Medicine, 41 (1999): 625–31.Google Scholar
Bell, A., “CNA Asks Whether Some MC Plans Save Money,” National Underwriter & Health (Financial Services edition), 101, no. 17 (1997): 7–8.Google Scholar
Id. at 368–75. Not everyone agrees that these laws are good for the consumer. Hyman, supra note 65, argued that the rise of “consumer protection” laws “undermines the ability of MCOs to tailor their coverage, copayment, and premium structure to meet the demands of their customers, and … insulates emergency departments (EDs) and emergency medicine physicians from the market forces which are remaking the rest of the medical market place.”.Google Scholar
See Noah, B.A., “The Managed Care Dilemma: Can Theories of Tort Liability Adapt to the Realities of Cost Containment?,” Mercer Law Review, 48 (1997): 1219–64; Danzon, P.M., “Tort Liability: A Minefield for Managed Care?,” Journal of Legal Studies, 26 (1997): 491–519.Google Scholar
530 U.S. 211, 120 S. Ct. 2143 (2000).Google Scholar
Jacobson, P.D., “Legal Challenges to Managed Care Cost Containment Programs: An Initial Assessment,” Health Affairs, 18, no. 4 (1999): 69–85.CrossRefGoogle Scholar
Florida's law requires that insurance contracts include a binding arbitration clause for any medical benefit claim dispute. Fla. Stat. Ann. § 627.736(5) (West 2000).Google Scholar
Prager, L.O., “Kaiser Looks to Overhaul Arbitration,” American Medical News, July 28, 1997, at 1–2.Google Scholar
National Association of Insurance Commissioners, State Average Expenditures & Premiums for Personal Automobile Insurance in 1998 (Kansas City, Missouri: National Association of Insurance Commissioners, 2000): at 5.Google Scholar
Id. at Table 3.Google Scholar
Letter from V.R. Pinkerton, insurance analyst, Division of Insurance, State of Colorado, to B. Purcell (March 23, 2000). These figures included both managed care and coinsurance options.Google Scholar
Wencl, A. and Vacante, R., “Automobile Managed Care: Beware the Newest Scheme,” Trial, 33, no. 2 (1997): 18–24.Google Scholar
Iglehart, J.K., “The American Health Care System: Managed Care,” N. Engl. J. Med., 327 (1992): 742–47.CrossRefGoogle Scholar