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  1. Managed care, liability, and ERISA.

    Article - En anglais

    During the past decade, managed care health plans (MCHPs) have transformed the medical market place through private sector regulation of professional standards of care.

    Within corporate America's health plans, prospective utilization review has ratcheted down access to mental health care with legal insulation against liability for the consequences derived from the Employee Retirement Income Security Act (ERISA).

    Reported cases in the mental health field involve denial of in-patient benefits resulting in suicide.

    ERISA pre-empts state damage claims in these cases and insulates the private regulatory decision-makers.

    The market power of MCHPs and the new economic incentives of physicians leave patients witout knowledgeable advocates who will resist damaging denials of care.

    Commentary based on earlier case law on liability of managed care decision-makers was misleading.

    That case law did not take into account ERISA pre-emption and its consequences.

    Mots-clés Pascal : Organisation santé, Service santé, Soin intégré, Coût financement, Santé mentale, Etats Unis, Amérique du Nord, Amérique, Homme

    Mots-clés Pascal anglais : Public health organization, Health service, Managed care, Financing cost, Mental health, United States, North America, America, Human

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 99-0160792

    Code Inist : 002B18H05B. Création : 16/11/1999.