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The Legal Subtext of the Managed Care Environment: A Practitioner's Perspective

Published online by Cambridge University Press:  01 January 2021

Alice G. Gosfield
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Extract

For a health lawyer in private practice, the substance of any discussion of managed care turns on the developments in the health care marketplace. Without a doubt, the industry is rapidly moving from one frame of reference to a radically different one. It is no surprise then, that, in consulting me, my clients want to know what is and what will be, not what should be. They want at least to survive, if not be successful, in the whirlwind of restructuring that offers no clear choices, no clear outcomes, and significant legal liabilities if they do not perform effectively.

What I want to address in this article is how the consolidation of medical practices and the integration of delivery structures has outpaced the legal system's ability to regulate or guide the emerging health care market. This gap leaves physicians without proper legal guidance on how to balance their duties to their patients and their contractual obligations to managed care organizations (MCOs). A brief review of the case law to date highlights some of the legal and ethical issues that arise for physicians who practice in this environment.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 23 , Issue 3 , Fall 1995 , pp. 230 - 235
Copyright
Copyright © American Society of Law, Medicine and Ethics 1995

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References

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