Publication Date: October 01, 1997
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http://www.urban.org/url.cfm?ID=1000400
The spread of managed care organizations' (MCOs’) selective networks reduced patient access to services, along with provider access to paying patients, so many providers have lobbied for laws to force plans to contract with "any willing provider" and give patients "freedom of choice." In opposition are MCOs, which want full freedom to contract selectively to control prices and utilization. This article comprehensively described laws in all 51 jurisdictions, classified by relative strength, and assessed the policy implications. Most enactments are relatively weak, and all are limited in application by ERISA and the Federal HMO Act. An associative multivariate analysis also showed that states with laws also have higher HMO penetration and higher physician density, but smaller rural populations. This paper concluded that the strongest laws overly restrict the management of care, to the likely detriment of cost control. But where market power is rapidly concentrating, unrestrained selective contracting could diminish patient access to care and long-term competition. In the face of uncertainty about the impact of these laws, an intermediate approach may be better than all or nothing. States should consider mandating that plans offer point-of-service options, for a separate premium. This option guarantees patient choice of plans at the time of enrollment and of providers at the time of care, yet maintains plan ability to control core providers. (Journal of Health Politics, Policy and Law 1997 October; 22(5): 1133-1189).
Topics/Tags: | Health/Healthcare
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