title: Expanded managed care liability: what impact on employer coverage?
abstract: Policymakers are considering legislative changes that would increase managed care organizations' exposure to civil liability for withholding coverage or failing to deliver needed care. Using a combination of empirical information and theoretical analysis, we assess the likely responses of health plans and Employee Retirement Income Security Act (ERISA) plan sponsors to an expansion of liability, and we evaluate the policy impact of those moves. We conclude that the direct costs of liability are uncertain but that the prospect of litigation may have other important effects on coverage decision making, information exchange, risk contracting, and the extent of employers' involvement in health coverage.
authors.affiliation: Columbia University, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Studdert
authors.forename: W M
authors.initials: WM
authors.lastname: Sage
authors.forename: C R
authors.initials: CR
authors.lastname: Gresenz
authors.forename: D R
authors.initials: DR
authors.lastname: Hensler
mesh_terms: D003365:Costs and Cost Analysis; D003659:Decision Making, Organizational; D019461:Employee Retirement Income Security Act / Q000191:economics / Q000331:legislation & jurisprudence*; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000331:legislation & jurisprudence*; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence*; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000331:legislation & jurisprudence*; D016365:Liability, Legal / Q000191:economics; D008318:Malpractice / Q000331:legislation & jurisprudence; D008329:Managed Care Programs / Q000191:economics / Q000331:legislation & jurisprudence*; D011795:Surveys and Questionnaires; D014481:United States