简介
Despite the attention to the problem of protecting the health care interests of Americans, there is little consensus on what should be done politically or otherwise to address this problem. InProtecting American Health Care ConsumersEleanor DeArman Kinney, a nationally regarded expert on health policy and law, tackles the serious and ongoing debate among state and federal policymakers, health care providers, third-party payers, and consumers about how to provide procedural justice to patients in the present health care climate.
To promote and ensure consumer protection in an increasingly adversarial and complicated health-care culture, Kinney first analyzes the procedures by which consumer concerns are presently discerned and resolved and then explains why these systems are unsatisfactory. She also discusses problematic procedures for making coverage policy and quality standards and proposes reforms in a variety of processes that would enable all consumers, including the uninsured, to influence key policies and standards and also to raise concerns and obtain appropriate remedies.
As the first comprehensive treatment of administrative procedures in American health plans and other such institutions,Protecting American Health Care Consumerswill be welcomed by state and federal policymakers, managed care executives, and lawyers charged with designing and implementing protections for consumers in public and private health plans.
目录
Acknowledgments ix
1: Introduction I
The Theoretical Contextfor Procedural Protections / The Scope
of the Book
2: The Patient Protection Debate
Private Reform Proposals / Government Initiatives / Making Sense of
the Debate
3: Health Insurance Coverage in the United States 23
Historical Development of the American Health Insurance System / The
Universe of Private Health Insurance Coverage / The Universe of Public
Health Insurance Programs / The Problem of the Uninsured
4: Relevant Law and Theory 4I
Regulatory Law / Corporate and Tax Law Administrative Law I
Contract Law / Tort Law
5: The Universe of Consumer Concerns about Health Care 67
A Typology of Consumer Concerns / Tapping and Resolving Consumer
Concerns about Health Care / Institutional Mechanisms for Tapping
Consumer Concerns
6: The Universe of Medical Standards and Other Policies
Regarding Health Care 85
The Health-Care Quality Revolution and Medical Standardsetting /
Organizations That Make Health-Care Policies /A Taxonomy of Health-
Care Policies
7: Processes for Making Policies Regarding Health Care Io9
Processesfor Making Policies Regarding the Content and Quality of
Health Care I Policymaking RegardingAccess to Health-Care Services /
Policymaking Regarding the Cost of Health-Care Services / Policymaking
and Dissemination: The Example of Diabetes
8: Regimes for Tapping and Resolving Consumer Concerns
about Health Care I27
Extralegal Institutionsfor Tapping and Resolving Consumer Concerns /
Internal, External, andAdministrative Review /Judicial Review / Tort
Causes ofAction / Contract Causes ofAction / Statutory Causes of
Actions
9: Principles of Sound Procedural Protections I50
Principles of Sound Policymaking Procedures /Principlesfor Better Ways
to Tap and Resolve Consumer Concerns about Health Care IA Callfor
Better Empirical Information about Consumer Concerns
10: AVision of Reform 175
More Definite Allocation of Regulatory Responsibility / Policymaking
Reforms / Reforms for Tapping and Resolving Consumer Concerns about
Health Care / The Limits of Procedural Justice without Distributive
Justice
Notes 191
Index 261
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