Federal regulation of managed care: an impulse in search of a theory?
Although there is growing demand for regulation of the managed care industry, regulatory proponents have yet to articulate a clear theory of regulation. Most observers acknowledge consumer information problems that regulation could address, but there is no consensus regarding regulation of the broader public concern about restrictive medical-necessity determinations by health plans. Concerns about these issues--which fall within the gray areas of divergent clinical opinion--may be difficult or impossible to address by explicit regulation. If policymakers forbear on regulation of medical-necessity determinations, private market innovation may ultimately remedy this problem.
Moran
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D003254:Consumer Advocacy / Q000331:legislation & jurisprudence*; D019981:Health Care Sector / Q000331:legislation & jurisprudence; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D015273:Insurance Selection Bias; D008329:Managed Care Programs / Q000331:legislation & jurisprudence* / Q000592:standards; D011050:Policy Making; D014481:United States