Protecting American Health Care Consumers

Kinney Eleanor DeArman Kinney

Description

Despite the attention to the problem of protecting the health care interests of Americans, there is little consensus on what should be done politically or otherwise to address this problem. In Protecting American Health Care Consumers Eleanor DeArman Kinney, a nationally regarded expert on health policy and law, tackles the serious and ongoing debate among state and federal policymakers, health care providers, third-party payers, and consumers about how to provide procedural justice to patients in the present health care climate.To promote and ensure consumer protection in an increasingly adversarial and complicated health-care culture, Kinney first analyzes the procedures by which consumer concerns are presently discerned and resolved and then explains why these systems are unsatisfactory. She also discusses problematic procedures for making coverage policy and quality standards and proposes reforms in a variety of processes that would enable all consumers, including the uninsured, to influence key policies and standards and also to raise concerns and obtain appropriate remedies.As the first comprehensive treatment of administrative procedures in American health plans and other such institutions, Protecting American Health Care Consumers will be welcomed by state and federal policymakers, managed care executives, and lawyers charged with designing and implementing protections for consumers in public and private health plans.

Sujets

• Droit et juridique
• USA
• États-Unis

Informations

• Publié par: Duke University Press
• Date de parution: 08 mai 2002
• Nombre de lectures: 0
• EAN13: 9780822383536
• Langue: English

Extrait

p r o t e c t i n g a m e r i c a n h e a lt h c a r e c o n s u m e r s

Eleanor DeArman Kinney

Protecting American

Health Care Consumers

Duke University Press Durham & London

2002

All rights reserved

∫2002 Duke University Press

Printed in the United States of America on acid-free paper$

Designed by C. H. Westmoreland

Typeset in Plantin Light and Frutiger display by

Keystone Typesetting, Inc.Library of Congress Cataloging-in-Publication Data

appear on the last printed page of this book.

In loving memory of my father,

dr. thomas d. ki nney,

who taught me how to live and write, and

with loving thanks to my mother,

dr. eleanor roberts ki nney,

for all her unfailing support throughout

my life

Acknowledgments

ix

Contents

1 : Introduction 1 The Theoretical Context for Procedural Protections / The Scope of the Book

2 : 11The Patient Protection Debate Private Reform Proposals / Government Initiatives / Making Sense of the Debate

3 : Health Insurance Coverage in the United States 23 Historical Development of the American Health Insurance System / The Universe of Private Health Insurance Coverage / The Universe of Public Health Insurance Programs / The Problem of the Uninsured

4 : Relevant Law and Theory 41 Regulatory Law / Corporate and Tax Law / Administrative Law / Contract Law / Tort Law

5 : The Universe of Consumer Concerns about Health Care 67 A Typology of Consumer Concerns / Tapping and Resolving Consumer Concerns about Health Care / Institutional Mechanisms for Tapping Consumer Concerns

6 : The Universe of Medical Standards and Other Policies Regarding Health Care 85 The HealthCare Quality Revolution and Medical Standardsetting / Organizations That Make HealthCare Policies / A Taxonomy of Health Care Policies

7 : 109Processes for Making Policies Regarding Health Care Processes for Making Policies Regarding the Content and Quality of Health Care / Policymaking Regarding Access to HealthCare Services / Policymaking Regarding the Cost of HealthCare Services / Policymaking and Dissemination: The Example of Diabetes

viii

8 : Regimes for Tapping and Resolving Consumer Concerns about Health Care 127 Extralegal Institutions for Tapping and Resolving Consumer Concerns / Internal, External, and Administrative Review / Judicial Review / Tort Causes of Action / Contract Causes of Action / Statutory Causes of Actions

9 : 150Principles of Sound Procedural Protections Principles of Sound Policymaking Procedures / Principles for Better Ways to Tap and Resolve Consumer Concerns about Health Care / A Call for Better Empirical Information about Consumer Concerns

10 : A Vision of Reform 175 More Definite Allocation of Regulatory Responsibility / Policymaking Reforms / Reforms for Tapping and Resolving Consumer Concerns about Health Care / The Limits of Procedural Justice without Distributive Justice

Notes

Index

191

261

Contents

Acknowledgments

There have been many who have helped me with this book in many very di√erent ways. First, I would like to thank my husband, Charles M. Clark, M.D., my mother, Eleanor R. Kinney, Ph.D., and my children, Jennie, Brian, and Margaret, for their support in innumerable ways for this proj- ect. I would also like to thank the sta√ at the Center for Law and Health at the Indiana University School of Law—Indianapolis for their invalu- able help, including my research assistants Julie Reed, Andrij Susla, Je√rey Kerner, Greg Gulick, Kristen Meyer, Helaine Hatter, Narendra Pleas, Erica Franklin, Teresa Hall, Robyn Daugherty, Jodi Herron, Kyle Ferrell, Faith Long, and Alejondra Conconi. I would especially like to thank No- buko Kudo for her excellent work on the preparation of the index and the final proofreading of this book. I would also like to thank Claudia Porretti and Phyllis Bonds, the current and former administrators of the Center for Law and Health, as well as my colleague Dr. David Orentlicher, the co- director of the center. Without the assistance of these people, this book would never have been completed. Many others provided me space and resources for my work on this book. In that regard, I would like to thank the administration of the Indiana University School of Law—Indianapolis for both financial and moral sup- port for the completion of the book. I would also like to thank my col- leagues at the Institute of Latin American Integration at the National Uni- versity of Law Plata in La Plata, Argentina, for the wonderful atmosphere in which to work and complete much of the work on this book. I would also like to thank the Council on International Exchange of Scholars for my Fulbright Fellowship for teaching and research in Argentina, which sup- ported my work in Argentina. Finally, many colleagues and friends o√ered extensive comments and suggestions on drafts of chapters of this book that were extremely helpful in focusing and improving them. In particular, I would like to thank Pro- fessors Gary Spitko, Ron Krotozinski, Andy Klein, and Dan Cole of my faculty for their support and comments. I would also like to thank col- leagues from other schools and institutions for their invaluable assistance as well, including Marc Rodwin of the Su√ock University School of Law, Bill Sage of the Columbia University School of Law, Fran Miller of the