Managed care, liability, and ERISA.
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
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0160792
Code Inist : 002B18H05B. Création : 16/11/1999.