Download or read book Law and Practice of Private Health Insurance and Managed Care written by Christian Funk and published by diplom.de. This book was released on 2000-04-28 with total page 147 pages. Available in PDF, EPUB and Kindle. Book excerpt: Inhaltsangabe:Abstract: A true revolution has taken place in the financing of health care in America. Today, managed care is dominating the way Americans receive and pay for their health care. With the rise of managed care medicine has been wrenched out of its atomized world of solo physician practices and community hospitals and has been transformed into a modern industry of giant for-profit companies traded on Wall Street. The current marketplace is characterized by mergers, acquisitions and the establishment of giant multi-billion dollar healthcare networks. Hospitals and managed care plans run big advertisement campaigns in the media, praising their products and services in order to get the biggest share possible of the $1.1 trillion America spends on health care each year. All parties involved in providing health care lobby for their interests at all levels of political decision-making in order to influence legislators and policymakers. Today s health care market changes quickly and at a high rate. New variations of managed care arise constantly making any analysis of managed care an ongoing game of "catch-up" with the marketplace. While writing this paper, for example, UnitedHealthcare dropped one of the major managed care instruments, utilization review, to address public s concerns and pending legislation. This paper will take a snapshot of managed care on the eve of the new millennium by using the most recent information available. After this introduction, the paper will give a description of the current American health care system in chapter two (The U.S. Health Care System). Then, the paper will focus on two aspects: A detailed description of managed care in chapter three (Managed Care) and an introduction of the main issues connected with this way of providing health care in chapter four (Managed Care issues). The paper will argue in chapter five (Results and Future Developments), that managed care of the future will be a light version of what is currently existing, resulting in less strict restrictions and more freedom for patients and doctors. Finally, the report will focus on recent developments in Germany, where policy-makers have started to adopt particular elements of managed care. In chapter six (Managed Care Approaches in Germany), the paper will argue, that Germany should pay more attention to the American experiences regarding managed care in order to prevent harm for patients in [...]
Download or read book Health Care Utilization as a Proxy in Disability Determination written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-04-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Download or read book Strangers in the Night written by Peter D. Jacobson and published by Oxford University Press. This book was released on 2002-08-08 with total page 497 pages. Available in PDF, EPUB and Kindle. Book excerpt: More than ever before, the legal system plays a vital role in virtually every aspect of the current health care system. From the congressional debate over patients' rights legislation to judicial rulings on the denial of health care services, the legal system is integrally involved in the organization, financing, and delivery of health care. This book explains how the legal system helps shape health care delivery and policy, explores new ways of looking at the relationship between law and medicine, and reflects on why it all matters. The story focuses on the judicial response to the advent of managed care, especially challenges to cost containment initiatives, and shows how the legal system has facilitated managed care's dominance over the health care system. An equally important part of the story is the evolution of the relationship between physicians and attorneys and how their mutual antagonism affects patient care. In the end, the stories come together around a strategy for reconciling the difficult health policy choices the country faces and for restoring the physician-patient relationship to the center of health care delivery.
Download or read book Care Without Coverage written by Institute of Medicine and published by National Academies Press. This book was released on 2002-06-20 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Download or read book The Law of Health Care Organization and Finance written by Barry R. Furrow and published by West Academic Publishing. This book was released on 2004 with total page 820 pages. Available in PDF, EPUB and Kindle. Book excerpt: A spin-off publication of Health Law: Cases, Materials & Problems, 5th Edition, the text begins with an introduction to fundamental concepts affecting law and policy. The next chapter considers quality control in the health care setting. The following four chapters examine issues central to structuring integrated systems and the organization of health care institutions. It also covers the problem of health care access and cost control issues, with particular attention paid to the ongoing policy debate about the proper role of government and the nation's responsibilities to provide health care for indigent citizens. Examines legal oversight of private health financing, and looks at Medicare and Medicaid.
Download or read book The Law of American Health Care written by Nicole Huberfeld and published by Aspen Publishing. This book was released on 2023-02-20 with total page 1165 pages. Available in PDF, EPUB and Kindle. Book excerpt: The purchase of this ebook edition does not entitle you to receive access to the Connected eBook on CasebookConnect. You will need to purchase a new print book to get access to the full experience including: lifetime access to the online ebook with highlight, annotation, and search capabilities, plus an outline tool and other helpful resources. A student-friendly casebook for the new generation of health lawyers in an evolving legal landscape, The Law of American Health Care emphasizes lightly, carefully edited primary source excerpts, plain-language exposition, focused comprehension questions, and problems for concept application. It introduces key themes and uses them as a conceptual anchor so when the law inevitably changes, students have tools to nimbly move forward. These themes include: federalism; individual rights; fiduciary relationships; the administrative state; markets and regulation; and equity and distribution. The book engages topics in-depth, to give students a comprehensive understanding of the most important features of health care law and hands-on experience working through cutting-edge issues. New to the 3rd Edition: Current debates about government power among public health officials, legislatures, judges, and other state actors, including issues arising from the COVID-19 pandemic Public insurance materials reorganized so students can better absorb Medicare/Medicaid and apply lessons of the pandemic and litigation over various issues Solidification of ACA reforms, including surprise billing legislation and changes in the exchange subsidies that attempted to fill the Medicaid coverage gap Consolidated health care business organization materials New/revised materials and new cases in tax exempt entities and health care fraud/abuse, state action doctrine, and discrimination in healthcare/health insurance (including history of attempts to address health care discrimination, 1964 Civil Rights Act Title VI, ADA, HIPAA portability, ACA guaranteed issue, renewal, community rating, and Section 1557) Government enforcement’s more aggressive approach to labor issues Dobbs v. Jackson Women’s Health and ensuing state law chaos and federal/state conflicts Increased use of digital health care tools and telehealth driven by the pandemic Right-to-try movement and other features of biomedical research that became more relevant during the pandemic Benefits for instructors and students: Practice-oriented approach immerses students in primary source materials that include judicial opinions as well as statutory, regulatory, advisory, and empirical sources used in practice Focused on needs of students practicing health care law in a post-ACA, pandemic-impacted world First health care law casebook to reorient federal law as central authority for health care regulation (as opposed to state or common law) Exploration of two major public insurance programs provided before discussion of private insurance options, intentionally suggesting the increasing primacy of social insurance in the U.S. and underscoring even the most uniform coverage (Medicare) is complex Intro chapter with critical organizing themes and in-depth case studies which are woven throughout other chapters, including more prominent emphasis on equity and distributive justice Text boxes highlight key lessons and help explain/enhance material Directed Questions, hypothetical Problems, and end-of-chapter Capstone Problems support focused reading and clearer synthesis of major issues Manageable length Focused on topics encountered in the day-to-day practice of health law Essential connective narrative without overwhelming notes New co-author with deep health care legislative and regulatory experience
Download or read book Essentials of Health Policy and Law written by Joel Bern Teitelbaum and published by Jones & Bartlett Publishers. This book was released on 2013 with total page 309 pages. Available in PDF, EPUB and Kindle. Book excerpt: Given the prominent role played by policy and law in the health of all Americans, the aim of this book is to help readers understand the broad context of health policy and law. The essential policy and legal issues impacting and flowing out of the health care and public health systems, and the way health policies and laws are formulated. Think of this textbook as an extended manual.introductory, concise, and straightforward.to the seminal issues in U.S. health policy and law, and thus as a jumping off point for discussion, reflection, research, and analysis.
Download or read book The Law of Health Care Finance and Regulation written by Mark A. Hall and published by Aspen Publishing. This book was released on 2018-05-11 with total page 907 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Law of Health Care Finance and Regulation is based on Part III, “Institutions, Providers, and the State,” of parent book Health Care Law and Ethics and adds additional coverage of a variety of issues that have shaped health care finance law. Integrating public health, financial and ethical issues, this casebook uses compelling case law, clear notes and comprehensive background information to illuminate the complex and dynamic field of health care law. Key Features: Based on material in Part III of the popular parent book, “Institutions, Providers, and the State,” along with coverage of duty to treat, hospital liability, managed care liability, and regulating access to drugs. Includes cases and material not found in the parent book on: • Judicial and administrative review of Medicare decisions. Certificate of need laws. Review immunity. Integrates public health and ethics issues and features clear notes that provide context, smooth transitions between cases, and background information. Website provides background materials, updates of important events, additional relevant topics and links to other resources on the Internet.
Download or read book The Privatization of Health Care Reform written by M. Gregg Bloche and published by Oxford University Press. This book was released on 2002-10-17 with total page 245 pages. Available in PDF, EPUB and Kindle. Book excerpt: Markets, not politics, are driving health care reform in America today. Inventive entrepreneurs have transformed medicine over the past ten years, and no end to this period of rapid change is in sight. Consumer anxieties over managed care are mounting, and medical costs are again soaring. Meanwhile, the federal government remains mostly on the health policy sidelines, as it has since the collapse of the Clinton administration's campaign for health care reform. This book addresses the changes that the market has wrought- and the challenges this transformation poses for courts and regulators. The law that governs the medical marketplace is an incomplete, overlapping patchwork, conceived mainly without medical care specifically in mind. The ensuing confusion and incoherence are a central theme of this book. Fragmentation of health care lawmaking has foreclosed coordinated, system-wide policy responses, and lack of national consensus on many of the central questions in health care policy has translated into legal contradiction and bitter controversy. Written by leading commentators on American health law and policy, this book examines the widely-perceived failings of managed care and the law's relationship to them. Some of the contributors treat law as a cause of trouble; others emphasize the law's potential and limits as a corrective tool when the market disappoints. The first two chapters present contrasting overviews of how the doctrines and decision-makers that constitute health law work together, for better or worse, to constrain the medical marketplace. The next six chapters address particular market developments and regulatory dilemmas. These include the power of state versus federal government in the health sphere, conflict between insureres and patients and providers over medical need, financial rewards to physicians for frugal practice, the role of antitrust law in the organization of health care provision and financing, the future of public hospitals, and the place of investor-owned versus non-profit institutions. Acknowledging the health sphere's complexities, the authors seek remedies that fit this country's legal, political, and cultural constraints and can contribute to reasoned regulatory goverance. Within limits they believe a measure of rationality is possible.
Download or read book Healthcare Law and Ethics written by Dean M. Harris and published by . This book was released on 1999 with total page 342 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Regulating Managed Care written by Stuart H. Altman and published by Jossey-Bass. This book was released on 1999-06-25 with total page 408 pages. Available in PDF, EPUB and Kindle. Book excerpt: What should be government's role in a market-oriented health caresystem? What's the appropriate amount of regulation? Who should regulate-states, federal government, or marketforces? What role do the courts play in this regulation? Are there existing models that might guide leaders in designing aneffective regulatory structure? Welcome to the great managed care debate. In Regulating ManagedCare, twenty-six of the nation's leading health policy experts givehealth care administrators, clinicians, and policy makers insightinto the issues behind this critical exchange and provide leaderswith a road map to assess the policy options available to protectthe quality of our health care delivery system. "This collection of papers, from an extraordinary group of authors,makes a valuable contribution to the ongoing policy debate and willbe of interest to anyone concerned with the future of our healthcare system."---Charles A. Sanders, retired chairman and CEO GlaxoInc. and former general director, Massachusetts General Hospital
Download or read book The Oxford Handbook of U S Health Law written by I. Glenn Cohen and published by Oxford University Press. This book was released on 2016-11-18 with total page 1233 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Oxford Handbook of U.S. Health Law covers the breadth and depth of health law, with contributions from the most eminent scholars in the field. The Handbook paints with broad thematic strokes the major features of American healthcare law and policy, its recent reforms including the Affordable Care Act, its relationship to medical ethics and constitutional principles, and how it compares to the experience of other countries. It explores the legal framework for the patient experience, from access through treatment, to recourse (if treatment fails), and examines emerging issues involving healthcare information, the changing nature of healthcare regulation, immigration, globalization, aging, and the social determinants of health. This Handbook provides valuable content, accessible to readers new to the subject, as well as to those who write, teach, practice, or make policy in health law.
Download or read book State by State Guide to Managed Care Law 2007 Edition written by John F. Buckley, IV and published by . This book was released on 2006-11-22 with total page 544 pages. Available in PDF, EPUB and Kindle. Book excerpt: Until now, the search for information on managed care was much more difficult than it had to be. Now you can examine and compare regulatory policies state by state. State-by-State Guide to Managed Care Law simplifies and expedites your research by giving you immediate access to key court decisions, state managed care policies and practices and extensive citations to codes and regulations -- for all 50 states. Identify your issue in the index and turn to the page indicated. You'll find current, authoritative information that can help you to: Evaluate baseline quality standards - Determine when managed care enrollees have access to providers - Establish guidelines for collection and disclosure of financial information - Arm yourself to tackle the complicated issue of prescription drugs - Ensure that the managed care organization recognizes patients' and providers' due process rights. Managed care is undeniably a permanent part of the health care landscape, so keep this portable and precise reference close at hand for daily consultation.
Download or read book Managed Care Liability written by David L. Leitner and published by American Bar Association. This book was released on 1997 with total page 496 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Managed Care and Private Insurance written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-12-21 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed Care, and Private Insurance
Download or read book Coverage Matters written by Institute of Medicine and published by National Academies Press. This book was released on 2001-10-27 with total page 204 pages. Available in PDF, EPUB and Kindle. Book excerpt: Roughly 40 million Americans have no health insurance, private or public, and the number has grown steadily over the past 25 years. Who are these children, women, and men, and why do they lack coverage for essential health care services? How does the system of insurance coverage in the U.S. operate, and where does it fail? The first of six Institute of Medicine reports that will examine in detail the consequences of having a large uninsured population, Coverage Matters: Insurance and Health Care, explores the myths and realities of who is uninsured, identifies social, economic, and policy factors that contribute to the situation, and describes the likelihood faced by members of various population groups of being uninsured. It serves as a guide to a broad range of issues related to the lack of insurance coverage in America and provides background data of use to policy makers and health services researchers.
Download or read book The Law and American Health Care written by Kenneth R. Wing and published by Aspen Publishers. This book was released on 1998 with total page 1304 pages. Available in PDF, EPUB and Kindle. Book excerpt: This casebook concentrates on the main issue dominating the health care industry today -- finance. Authors Wing, Jacobs, and Kuszler keep their discussion lively and relevant by introducing topics other books ignore, such as bioethics, antitrust, fraud and abuse, white collar crime in health law, and health care reform. By treating health care as a regulated industry with strong social policy implications, "The Law and American Health Care" effectively conveys the necessary legal knowledge as well as the distinct professional character and tortuous history of the field. After an introductory chapter sets the stage, the authors confront today's hottest topics: -- Health Care Financing: Who Pays for Health Care? -- Health Care Facilities: Regulation, Reimbursement, and Cost Containment -- Regulation and Reimbursement of Physicians and Other Individual Health Care Providers -- Individual and Institutional Liability for Malpractice -- Antitrust -- Fraud and Abuse -- White Collar Crime in Health Care -- Integrating Financing, Delivery, and Management of Health Care -- Health Care Reform in the 1990s A well-balanced mix of cases, problems, questions, and notes lead students through the material: -- A generous selection of recent cases demonstrate the real-life consequences of issues under discussion -- Problems stimulate class debate and can also be used on exams Throughout the book, the authors highlight issues of underlying policy and actual practice in the field. The accompanying Teacher's Manual helps instructors choose material to meet individual course needs.
