Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-19T18:48:52.168Z Has data issue: false hasContentIssue false
  • English
  • Français

Payors, Data, and Nudges to Improve Care

Published online by Cambridge University Press:  01 January 2021

Wendy Netter Epstein
Get access Rights & Permissions [Opens in a new window]

Abstract

Unnecessary health care is a tremendous problem that negatively impacts individuals and also increases health care costs across the system. While much scholarly attention has been paid to the role of patients and providers, payors' role in contributing to the problem is underexplored. The article recommends that payors should nudge providers away from unnecessary care by requiring electronic alerts intended to deter unnecessary care.

Type
Symposium Articles
Information
Journal of Law, Medicine & Ethics , Volume 46 , Issue 4: Next Steps in Health Reform , Winter 2018 , pp. 927 - 930
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

See Kliff, S., “We Spend $750 Billion on Unnecessary Health Care. Two Charts Explain Why,” Washington Post: Wonkblog, September 7, 2012, available at <https://www.washington-post.com/news/wonk/wp/2012/09/07/we-spend-750-billion-on-unnecessary-health-care-two-charts-explain-why> (last visited December 11, 2018); A. Lowrey, “Study of U.S. Health Care System Finds Both Waste and Opportunity to Improve,” New York Times, September 11, 2012, available at <https://nyti.ms/2tR4FY4> (last visited December 11, 2018).+(last+visited+December+11,+2018);+A.+Lowrey,+“Study+of+U.S.+Health+Care+System+Finds+Both+Waste+and+Opportunity+to+Improve,”+New+York+Times,+September+11,+2012,+available+at++(last+visited+December+11,+2018).>Google Scholar
Armao, D., Semelka, R.C., and Elias, Jr., “Radiology's Ethical Responsibility for Healthcare Reform: Tempering the Overutilization of Medical Imaging and Trimming Down a Heavyweight,” Journal Magnetic Resonance Imaging 35, no. 3 (2012): 512–17 at 516; N. Nassery et al., “Systematic Overuse of Healthcare Services: A Conceptual Model,” Applied Health Economics & Health Policy 13, no. 1 (2015): 1-6, at 1-2.Google Scholar
Mantel, J., “Spending Medicare’s Dollars Wisely: Taking Aim at Hospitals’ Cultures of Overtreatment,” University Michigan Journal Law Reform 49, no. 1 (2015): 121–77, at 132-33; R.S. Saver, “Health Care Reform’s Wild Card: The Uncertain Effectiveness of Comparative Effectiveness Research,” University Pennsylvania Law Review 159, no. 6 (2011): 2147-2207, at 2174.Google Scholar
Jost, T.S., “The American Difference in Health Care Costs: Is There a Problem? Is Medical Necessity the Solution?” Saint Louis University Law Journal 43, no. 1 (1999): 1–26, at 15.Google Scholar
Hall, M.A. and Schneider, C. E., “Patients as Consumers: Courts, Contracts, and the New Medical Marketplace,” Michigan Law Review 106, no. 4 (2008): 643–689, at 653-656; W.N. Epstein, “Price Transparency and Incomplete Contracts in Health Care,” Emory Law Journal 67, no. 1 (2017): 1-58, at 3.Google Scholar
Baicker, K., Chandra, A., and Skinner, J.S., “Saving Money or Just Saving Lives? Improving the Productivity of US Health Care Spending,” Annual Review Economic 4 (2012): 33–56, at 38.Google Scholar
See Jost, supra note 4, at 17.Google Scholar
Harrow, R., “Why Health Insurance Prices Will Continue to Rise in 2016 and Beyond,” Forbes, January 14, 2016, available at <https://www.forbes.com/sites/robertharrow/2016/01/14/why-health-insurance-prices-will-continue-to-rise-in-2016-and-beyond/#193e6b6b5e22> (last visited November 1, 2018); L.S. Dafny, “Are Health Insurance Markets Competitive?” American Economic Review 100, no. 4 (2010): 1399-1431, at 1400, 1426.+(last+visited+November+1,+2018);+L.S.+Dafny,+“Are+Health+Insurance+Markets+Competitive?”+American+Economic+Review+100,+no.+4+(2010):+1399-1431,+at+1400,+1426.>Google Scholar
See, e.g., Ariz. Admin. Code § R9-22-101 (2017); La. Stat. Ann. § 22:2392 (2015).Google Scholar
Grosso, S.M., “Rethinking Malpractice Liability and ERISA Preemption in the Age of Managed Care,” Stanford Law & Policy Review 9, no. 2 (1998): 433–461, at 435.Google Scholar
See, e.g., Schuck, P. H., “Rethinking Informed Consent,” Yale Law Journal 103, no. 4 (1994): 899–959, at 924; Erin Sheley, “Rethinking Injury: The Case of Informed Consent,” Brigham Young University Law Review 2015, no. 1 (2015): 63-120, at 63; N.N. Sawicki, “Modernizing Informed Consent: Expanding the Boundaries of Materiality,” University of Illinois Law Review 2016, no. 3 (2016): 821-872, at 827.CrossRefGoogle Scholar
Emanuel, E.J. and Fuchs, V. R., “Health Care Overutilization in the United States — Reply,” Journal of American Medical Association, November 19, 2008, available at <https://jamanetwork.com/journals/jama/article-abstract/182911?resultClick=1> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
Thaler, R.H. and Sunstein, C.R., “Libertarian Paternalism,” American Economic Review 93, no. 2 (2003): 175–179, at 175 (coining the term “Libertarian Paternalism.”); Thaler, R.H. and Sunstein, C.R., Nudge: Improving Decisions About Health, Wealth and Happiness (New York: Penguin Group, 2008): at 4-6.Google Scholar
Id.Google Scholar
See, e.g., Sunstein, C.R., Why Nudge? The Politics of Libertarian Paternalism (Yale University Press, 2014): at 59; See, e.g., K.R. Laughery and M.S. Wogalter, Designing Effective Warnings, Reviews of Human Factors and Ergonomics, available at <http://www.safetyhumanfactors.org/wp-content/uploads/2011/12/283LaugheryWogalter2006.pdf> (last visited October 31, 2018), at 241–42.Google Scholar
See, e.g., Capron, A. and Spruijt-Metz, D., “Behavioral Economics in the Physician-Patient Relationship: A Possible Role for Mobile Devices and Small Data” in Cohen, I.G., Lynch, H.F., and Robertson, C.T., eds., Nudging Health: Health Law and Behavioral Economics (Johns Hopkins University Press, 2016), at 234.Google Scholar
See Epstein, W.N., “The Health Insurer Nudge,” Southern California Law Review 91, no. 4 (2018): 593–656.Google Scholar
Wolfson, D. et al., “Engaging Physicians and Consumers in Conversations About Treatment Overuse and Waste: A Short History of the Choosing Wisely Campaign,” Academic Medicine 89, no. 7 (2014): 990–995, at 990; Choosing Wisely, available at <http://www.choosingwisely.org> (last visited November 1, 2017).+(last+visited+November+1,+2017).>Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Byrne, C. et al., Advancing Clinical Decision Support Key Lessons in Clinical Decision Support Implementation, Westat, available at <https://www.healthit.gov/sites/default/files/acds-lessons-in-cds-implementation-deliverablev2.pdf> (last visited November 1, 2018), at 1.Google Scholar
Id.Google Scholar
Ridgely, M.S. and Greenberg, M.D., “Too Many Alerts, Too Much Liability: Sorting Through the Malpractice Implications of Drug-Drug Interaction Clinical Decision Support,” Saint Louis University Journal of Health Law & Policy 5, no. 2 (2012): 257–296, at 280.Google Scholar
See Id. at 279-280.Google Scholar
See, e.g., Chernew, M. et al., “Value-Based Insurance Design,” Health Affairs 26, no. 2 (2007): w195–w203.Google Scholar
See Epstein, supra note 17, at 650-655.Google Scholar