Managed care regulation in the states: The impact on physicians' practices and clinical autonomy

Journal of Health Politics, Policy and Law

Volumn 34, Issue 2, 2009, Pages 219-259

  Kronebusch, Karl ^a   Schlesinger, Mark ^b   Thomas, Tracey ^b  

^a CITY UNIVERSITY OF NEW YORK   (United States)

^b YALE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CLINICAL COMPETENCE; CLINICAL DECISION MAKING; CLINICAL PRACTICE; CONSUMER; FINANCIAL MANAGEMENT; HEALTH CARE ACCESS; HEALTH CARE DELIVERY; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH CARE QUALITY; HUMAN; LAW; MEDICAL SERVICE; PATIENT REFERRAL; PHYSICIAN; PROFESSIONAL PRACTICE;

CONTRACTS; DEMOGRAPHY; FEMALE; HEALTH SERVICES ACCESSIBILITY; HUMANS; MALE; MANAGED CARE PROGRAMS; PHYSICIAN'S PRACTICE PATTERNS; PROFESSIONAL AUTONOMY; QUALITY OF HEALTH CARE; REFERRAL AND CONSULTATION; SPECIALTIES, MEDICAL; STATE GOVERNMENT; UNITED STATES;

EID: 65649142992     PISSN: 03616878     EISSN: 15271927     Source Type: Journal    
DOI: 10.1215/03616878-2008-045     Document Type: Article

References (91)

1. Altman, S. H., U. E. Reinhardt, and D. Shactman, eds. 1999. Regulating Managed Care: Theory, Practice, and Future Options. San Francisco: Jossey-Bass.
2. Baker, L. 1997. The Effect of HMOs on Fee-for-Service Health Care Expenditures: Evidence from Medicare. Journal of Health Economics 16: 453-481. (Pubitemid 27296991)
3. Baker, L. C., and J. Chan. 2007. Laws Requiring Health Plans to Provide Direct Access to Obstetricians and Gynecologists, and Use of Cancer Screening by Women. HSR: Health Services Research 42: 990-1007. (Pubitemid 46699475)
4. Bamezai, A., J. Zwanziger, G. A. Melnick, and J. M. Mann. 1999. Price Competition and Hospital Cost Growth in the United States (1989-1994). Health Economics 8: 233-243.
5. Billi, J. E., and G. B. Agrawal, eds. 2001. The Challenge of Regulating Managed Care. Ann Arbor: University of Michigan Press.
6. Blendon, R., and J. Benson. 2001. Americans' Views on Health Policy: A Fifty-Year Historical Perspective. Health Affairs 20 (2): 33-46.
7. Blendon, R. J., M. Brodie, J. M. Benson, D. E. Altman, L. Levitt, T. Hoff, and L. Hugick. 1998. Understanding the Managed Care Backlash. Health Affairs 17 (4): 80-94.
8. Bloche, M. G. 2002. Trust and Betrayal in the Medical Marketplace. Stanford Law Review 55: 919-954.
9. -. 2003. One Step Ahead of the Law: Market Pressures and the Evolution of Managed Care. In The Privatization of Health Care Reform, ed. M. G. Bloche, 22-48. New York: Oxford University Press.
10. Bloche, M. G., and D. M. Studdert. 2004. A Quiet Revolution: Law as an Agent of Health System Change. Health Affairs 23 (2): 29-42.
11. Brown, L., and E. Eagan. 2004. The Paradoxical Politics of Provider Re-empowerment. Journal of Health Politics, Policy and Law 29: 1045-1071.
12. Bundorf, M. K., K. A. Schulman, J. A. Safford, D. Gaskin, J. G. Jollis, and J. J. Escarce. 2003. Impact of Managed Care on the Treatment, Costs and Outcomes of Fee-for-Service Medicare Patients with Acute Myocardial Infarction. Health Services Research 39 (1): 131-152.
13. Card, D. 1992. Do Minimum Wages Reduce Employment? A Case Study of California, 1987-89. Industrial and Labor Relations Review 46: 38-54.
14. Card, D., and A. B. Krueger. 1994. Minimum Wages and Employment: A Case Study of the Fast-Food Industry in New Jersey and Pennsylvania. American Economic Review 84: 772-793.
15. Carroll, A., and J. M. Ambrose. 2002. Any-Willing-Provider Laws: Their Financial Effect on HMOs. Journal of Health Politics, Policy and Law 27: 927-945. (Pubitemid 36135087)
16. Center for Studying Health System Change. 2001. Community Tracking Study, Physician Survey Restricted Use File: User's Guide. Technical Publication 12. Washington, DC: Center for Studying Health System Change.
17. Collins, K. S., C. Schoen, and D. Sandman. 1997. The Commonwealth Fund Survey of Physician Experiences with Managed Care. New York: Commonwealth Fund.
18. Cunningham, P., and L. Felland. 2008. Falling Behind: Americans' Access to Health Care Deteriorates, 2003-2007. Tracking Report No. 19. Washington, DC: Center for Studying Health System Change.
19. Cunningham, P. J., C. Denk, and M. Sinclair. 2001. Do Consumers Know How Their Health Plan Works? Health Affairs 20 (2): 159-166.
20. Dato, V., L. Ziskin, M. Fulcomer, R. M. Martin, and K. Knoblauch. 1996. Average Postpartum Length of Stay for Uncomplicated Deliveries - New Jersey, 1995. Morbidity and Mortality Weekly Report 45: 700-705.
21. Declerq, E., and D. Simmes. 1997. The Politics of "Drive-Through Deliveries": Putting Early Postpartum Discharge on the Legislative Agenda. Milbank Quarterly 75: 175-202. (Pubitemid 36503250)
22. De Vilee, K. A. 1999. Managed Care and the Ethics of Regulation. Journal of Medicine and Philosophy 24: 402-517. (Pubitemid 30043401)
23. Dow, W. H., D. M. Harris, and Z. Liu. 2006. Differential Effectiveness in Patient Protection Laws: What Are the Causes? An Example from the Drive-Through Delivery Laws. Journal of Health Politics, Policy and Law 31: 1107-1127. (Pubitemid 46146103)
24. Draper, D., and G. Claxton. 2004. Managed Care Redux: Health Plans Shift Responsibilities to Consumers. Issue Brief No. 79. Washington, DC: Center for Studying Health System Change. (Pubitemid 34655287)
25. Draper, D., R. Hurley, C. Lesser, and B. Strunk. 2002. The Changing Face of Managed Care. Health Affairs 21 (1): 11-23.
26. Encinosa, W. 2001. The Economics of Regulatory Mandates on the HMO Market. Journal of Health Economics 20: 85-107.
27. Epstein, R. 1999. Managed Care under Siege. Journal of Medicine and Philosophy 24: 434-460. (Pubitemid 30043399)
28. Families USA Foundation. 1998. Hit and Miss: State Managed Care Laws. Washington, DC: Families USA.
29. General Accounting Office. 1997. Managed Care: Explicit Gag Clauses Not Found in HMO Contracts, but Physician Concerns Remain. GAO/HEHS-97-175. Washington, DC: General Accounting Office.
30. Gerber, B., and P. Teske. 2000. Regulatory Policymaking in the American States: A Review of Theories and Evidence. Political Research Quarterly 53: 849-886.
31. Glied, S., and J. G. Zivin. 2002. How Do Doctors Behave When Some (but Not All) of Their Patients Are in Managed Care. Journal of Health Economics 21: 337-353. (Pubitemid 34143150)
32. Gold, M., R. Hurley, T. Lake, T. Ensor, and R. Berenson. 1996. A National Survey of the Arrangements Managed-Care Plans Make with Their Physicians. New England Journal of Medicine 333: 1678-1687.
33. Gradison, B. 1999. Regulation from an Insurance Industry Perspective. In Regulating Managed Care: Theory, Practice, and Future Options, ed. S. H. Altman, U. E. Reinhardt, and D. Shactman, 276-281. San Francisco: Jossey-Bass.
34. Gray, B., and M. Field, eds. 1989. Controlling Costs and Changing Patient Care? The Role of Utilization Management. Washington, DC: National Academy Press.
35. Gruber, J., and J. Poterba. 1994. Tax Incentives and the Decision to Purchase Health Insurance: Evidence from the Self-Employed. Quarterly Journal of Economics 109: 701-733. (Pubitemid 24814229)
36. Grumbach, K., D. Osmond, K. Vranizan, D. Jaffe, and A. Bindman. 1998. Primary Care Physicians' Experience of Financial Incentives in Managed Care Systems. New England Journal of Medicine 339: 1516-1520.
37. Hall, M. 2005. The "Death" of Managed Care: A Regulatory Autopsy. Journal of Health Politics, Policy and Law 30: 427-452. (Pubitemid 40911367)
38. Hargraves, J. L., and H. Pham. 2003. Back in the Driver's Seat: Specialists Regaining Autonomy. Tracking Report No. 7. Washington, DC: Center for Studying Health System Change.
39. Hellinger, F. J. 2005. Commentary - Assessing the Impact of Managed Care Patient Protection Laws: Problems and Pitfalls. HSR: Health Services Research 40: 669-674.
40. Hoy, E., R. Curtis, and T. Rice. 1993. Change and Growth in Managed Care. Health Affairs 10 (4): 18-36.
41. Hurley, R., J. Grossman, T. Lake, and L. Casalino. 2002. A Longitudinal Perspective on Health Plan-Provider Risk Contracting. Health Affairs 21 (4): 144-153.
42. Ignagni, K. 1999. The Managed Care Industry: Balancing Market Forces and Regulation. In Regulating Managed Care: Theory, Practice, and Future Options, ed. S. H. Altman, U. E. Reinhardt, and D. Shactman, 239-262. San Francisco: Jossey- Bass.
43. Jacobs, L. R., and R. Y. Shapiro. 1999. The American Public's Pragmatic Liberalism Meets Its Philosophical Conservatism. Journal of Health Politics, Policy and Law 24: 1021-1031.
44. Jacobson, P. D. 2003. Who Killed Managed Care? A Policy Whodunit. Saint Louis University Law Journal 47: 365-396.
45. Jensen, G., K. Cotter, and M. Morrisey. 1995. State Insurance Regulation and Employers' Decisions to Self-Insure. Journal of Risk and Insurance 62: 185-213.
46. Jones, B. 1994. Reconceiving Decision-Making in Democratic Politics: Attention, Choice, and Public Policy. Chicago: University of Chicago Press.
47. Kaiser Family Foundation. 1999. Survey of Physicians and Nurses. Menlo Park, CA: Kaiser Family Foundation.
48. -. 2004. The Public, Managed Care, and Consumer Protection. Kaiser Health Poll Report, August 24. www.kff.org/healthpollreport.
49. Kemper, P., J. D. Reschovsky, and H. T. Hu. 1999/2000. Do HMOs Make a Difference? Summary and Implications. Inquiry 36: 419-425.
50. Kerr, E., R. Hays, A. Mitchinson, M. Lee, and A. Siu. 1999. The Influence of Gatekeeping and Utilization Review on Patient Satisfaction. Journal of General Internal Medicine 14: 287-296. (Pubitemid 29226674)
51. Korobkin, R. 1998. The Efficiency of Managed Care "Patient Protection" Laws: Incomplete Contracts, Bounded Rationality, and Market Failure. Cornell Law Review 85: 1-88. (Pubitemid 27162994)
52. Licari, M., and K. Meier. 1997. Regulatory Policy When Behavior Is Addictive: Smoking, Cigarette Taxes, and Bootlegging. Political Research Quarterly 50: 5-24.
53. Liner, R. 1997. Physician Deselection: The Dynamics of a New Threat to the Physician-Patient Relationship. American Journal of Law and Medicine 23: 511-537.
54. Liu, Z., W. Dow, and E. Norton. 2004. Effect of Drive-Through Delivery Laws on Postpartum Length-of-Stay and Hospital Discharges. Journal of Health Economics 23: 129-155. (Pubitemid 38202262)
55. Lundy, J., L. Levitt, and J. Wang. 2002. Trends and Indicators in the Changing Health Care Marketplace. Menlo Park, CA: Henry J. Kaiser Family Foundation.
56. Managed Care. 2003. Poll: Health Care Industry Needs More Regulation. May 2003. www.managedcaremag.com/archives/0305/0505.snapshot.html, accessed July 5, 2004.
57. Marquis, M. S., and S. Long. 1999. Trends in Managed Care and Managed Competition, 1993-97. Health Affairs 18 (6): 75-88.
58. Mays, G. P., G. Claxton, and J. White. 2004. Managed Care Rebound? Recent Changes in Health Plans' Cost Containment Strategies. Health Affairs, Web Exclusive W4-427-436 content.healthaffairs.org/cgi/reprint/hlthaff.w4.427v1.
59. Mays, G. P., R. E. Hurley, and J. M. Grossman. 2003. An Empty Toolbox? Changes in Health Plans' Approaches for Managing Costs and Care. Health Services Research 38: 375-393.
60. Mechanic, D. 2000. Managed Care and the Imperative for a New Professional Ethic. Health Affairs 19 (5): 100-111.
61. -. 2004. The Rise and Fall of Managed Care. Journal of Health and Social Behavior. 45 Suppl.: 76-86.
62. Meyer, B. D. 1995. Natural and Quasi-Experiments in Economics. Journal of Business and Economic Statistics 13: 151-161.
63. Miller, T. E. 1997. Managed Care Regulation: In the Laboratory of the States. Journal of the American Medical Association 278: 1102-1109.
64. -. 1998. Center Stage on the Patient Protection Agenda: Grievance and Appeal Rights. Journal of Law, Medicine and Ethics 26: 89-99.
65. Morrisey, M. A., and R. L. Ohsfeldt. 2004. Do "Any Willing Provider" and "Freedom of Choice" Laws Affect HMO Market Share? Inquiry 40: 362-374.
66. Mukamel, D. B., J. Zwanziger, and K. J. Tomaszewski. 2001. HMO Penetration, Competition, and Risk-Adjusted Hospital Mortality. Health Services Research 36: 1019-1035.
67. Noble, A., and T. Brennan. 1999. The Stages of Managed Care Regulation: Developing Better Rules. Journal of Health Politics, Policy and Law 24: 1275-1305. (Pubitemid 30013246)
68. Orentlicher, D. 1995. Physician Advocacy for Patients under Managed Care. Journal of Clinical Ethics 6 (4): 333-334.
69. Pauly, M., and M. L. Berger. 1999. Why Should Managed Care Be Regulated? In Regulating Managed Care: Theory, Practice, and Future Options, ed. S. H. Altman, U. E. Reinhardt, and D. Shactman, 53-74. San Francisco: Jossey-Bass.
70. Peterson, M., ed. 1999. The Managed Care Backlash. Journal of Health Politics, Policy and Law, Special Issue, 24: 873-1218.
71. Pollack, R. F. 1999. Regulation from a Consumer's Perspective. In Regulating Managed Care: Theory, Practice, and Future Options, ed. S. H. Altman, U. E. Reinhardt, and D. Shactman, 263-275. San Francisco: Jossey-Bass.
72. Quaye, R. 2001. Professional Integrity in the Age of Managed Care: Views of Physicians. International Journal of Health Care Quality Assurance 14 (2-3): 82-86.
73. Raetzman, S., L. Craig, and C. McDougall. 2001. Reforming the Health Care System: State Profiles, 2001. Washington, DC: AARP Public Policy Institute. (Pubitemid 20332341)
74. Reed, M. C., and S. Trude. 2002. Who Do You Trust? Americans' Perspectives on Health Care, 1997-2001. Tracking Report: Results from the Community Tracking Study, No. 3. Washington, DC: Center for Studying Health System Change.
75. Remler, D., K. Donelan, R. Blendon, G. Lundberg, L. Leape, D. Calkins, K. Binns, and J. Newhouse. 1997. What Do Managed Care Plans Do to Affect Care? Results from a Survey of Physicians. Inquiry 34: 196-204.
76. Ringquist, E. 1993. Does Regulation Matter? Evaluating the Effects of State Air Pollution Control Programs. Journal of Politics 55: 1022-1045.
77. Rosenthal, M., and M. Schlesinger. 2002. Not Afraid to Blame: The Neglected Role of Blame Attribution in Medical Consumerism and Some Implications for Health Policy. Milbank Quarterly 80: 41-95.
78. Schlesinger, M. 2002. On Values and Democratic Policymaking: The Fragile Consensus around Market-Oriented Medical Care. Journal of Health Politics, Policy and Law 27: 889-926. (Pubitemid 36135086)
79. Schlesinger, M., R. Dorwart, and S. Epstein. 1996. Managed Care Constraints on Psychiatrists' Hospital Practices: Bargaining Power and Professional Autonomy. American Journal of Psychiatry 153: 256-260. (Pubitemid 26038969)
80. Schlesinger, M., B. Gray, and K. Perreira. 1997. Medical Professionalism under Managed Care: The Pros and Cons of Utilization Review. Health Affairs 16 (1): 106-124.
81. Schlesinger, M., S. Mitchell, and B. Elbel. 2002. Voices Unheard: Barriers to the Expression of Dissatisfaction with Health Plans. Milbank Quarterly 80: 709-755.
82. Schlesinger, M., M. Wynia, and D. Cummins. 2000. Managed Care and Psychiatry: Some Distinctive Features and Their Implications for Clinical Practice. Harvard Review of Psychiatry 8 (5): 216-230.
83. Sloan, F., and M. Hall. 2002. Market Failures and the Evolution of State Regulation of Managed Care. Journal of Law and Contemporary Problems 65 (4): 169-206.
84. Sloan, F. A., J. R. Rattliff, and M. A. Hall. 2005. Impacts of Managed Care Patient Protection Laws on Health Services Utilization and Patient Satisfaction with Care. HSR: Health Services Research 40: 647-667. (Pubitemid 40791609)
85. -. 2007. Effects of State Managed Care Patient Protection Laws on Physician Satisfaction. Medical Care Research and Review 64: 585-599.
86. Strunk, B. C., and J. D. Reschovsky. 2002. Kinder and Gentler: Physicians and Managed Care, 1997-2001. Tracking Report No. 5. Washington, DC: Center for Studying Health System Change.
87. Tapay, N., J. Feder, and G. Dallek. 1998. Protection for Consumers in Managed Care Plans: A Comparison of Medicare, Medicaid, and the Private Insurance Market. Menlo Park, CA: Kaiser Family Foundation.
88. Udom, N. U., and C. L. Betley. 1998. Effects of Maternity-Stay Legislation on "Drive-Through Deliveries." Health Affairs 17 (5): 208-215. (Pubitemid 36503250)
89. U.S. Bureau of Labor Statistics, U.S. Department of Labor. 2005. National Compensation Survey: Employee Benefits in Private Industry in the United States, 2002-2003. Bulletin 2573, January.
90. Vita, M. G. 2001. Regulatory Restrictions on Selective Contracting: An Empirical Analysis of "Any-Willing-Provider" Regulations. Journal of Health Economics 20:955-966.
91. Wholey, D. R., J. B. Christianson, J. Engberg, and C. Bryce. 1997. HMO Market Structure and Performance, 1985 to 1995. Health Affairs 16 (6): 75-84.