title: Liability issues in managed care.
abstract: The explosive growth in Managed Care Organizations as a mechanism for providing health care in the United States has generated an equal explosion in litigation and new legislation related to problems within this delivery system. Abuses have included the "gagging" of physicians from providing full disclosure of medical options for their patients, inappropriate denial of care, denial of specialty referral, false claims data, insurer insolvency, economic credentialling, deselection, financial disincentives to render care, and lack of appeal or grievance mechanisms. These issues and others have resulted in injuries to patients and damage to the patient/physician relationship. This article discusses some of the more dramatic litigated cases and endeavors to alert both physicians and patients to potential legal matters that should be considered before becoming involved within this structure.
authors.affiliation: Otolaryngology-Head & Neck Surgery at LSU School of Medicine in New Orleans, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Ellis
mesh_terms: D003219:Confidentiality / Q000331:legislation & jurisprudence; D003254:Consumer Advocacy; D019461:Employee Retirement Income Security Act / Q000331:legislation & jurisprudence; D004992:Ethics, Medical; D007351:Insurance, Liability / Q000331:legislation & jurisprudence*; D008329:Managed Care Programs / Q000331:legislation & jurisprudence*; D010344:Patient Advocacy / Q000331:legislation & jurisprudence; D010817:Physician-Patient Relations; D012017:Referral and Consultation / Q000331:legislation & jurisprudence; D014481:United States; D014600:Utilization Review