Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Patient protection laws don’t favor health providers


Despite critics who say patients’ bills of rights laws are actually designed to protect health care providers, new research published in the current issue of the American Journal of Medicine found just the opposite.

"There is little evidence these laws have much impact on providers’ economic concerns," said Mark Hall, J.D., professor of law and public health at Wake Forest University Baptist Medical Center.

Hall reviewed managed care patient protection laws in the 48 states that have enacted them and also surveyed state regulators about law content. Commonly known as patients’ bills of rights, these laws are aimed at restraining the perceived excesses of managed care, including "gate-keeping," or denying insurance payment for medically necessary treatment and restricting patients’ choice of physicians Critics of the laws, however, say they actually provide protection to providers. Hall’s research was designed to assess the validity of these claims by evaluating the laws’ impacts.

After completing a review of state laws, Hall conducted in-depth case studies of six states – Iowa, Louisiana, Michigan, New Jersey, Texas and Virginia. The states were selected to ensure variety in location and size, the extent of patient protection laws and the market share of health maintenance organizations.

In each state, Hall conducted 16 to 24 confidential interviews with health plan managers, physician practices, regulators, patient advocates, industry observers and others. He also conducted a focus group with nine health care lawyers from across the country and conducted interviews at four of the largest national health plans.

Hall found that most of the patient protection laws are dominated by provisions that are directed primarily at patients’ rights. Laws that are directed primarily to providers’ interests are less frequent and are not very strong.

"The laws targeted most directly to protecting providers are not especially prominent in the overall package of state patient protection laws," writes Hall in the article.

One goal of the interviews was to determine whether provider interests were the main impetus for enacting the laws. Interviewees gave three primary reasons for the laws: media attention to managed care "horror stories," reaction to routine complaints about managed care, and a desire to prevent problems from arising.

"Provider advocacy and provider interests didn’t stand out as the dominant forces leading to enactment in most states, or nationally," said Hall.

When it comes to the effects of the laws, Hall found much the same thing: there is little evidence that they help providers economically. He reviewed the laws’ provisions that address whether insurance companies can exclude certain providers from their panels, how providers can be terminated from panels and other aspects of providers’ relationships with health plans.

He found that the laws do not deter health plans from being selective about which providers they include, do not create significant barriers to terminating providers and do not greatly improve the economic situation of providers.

"We found that managed care patient protection laws do not advance the agendas of providers more than they protect consumers," said Hall. "Instead, they appear to embody a convenient alignment of interests among providers, patients and lawmakers."

Hall said the findings are consistent with findings from similar studies, including one that found that these laws are a "curious mix of consumers’ rights, provider protection and patient protections."

Karen Richardson | EurekAlert!
Further information:

More articles from Studies and Analyses:

nachricht Diagnoses: When Are Several Opinions Better Than One?
19.07.2016 | Max-Planck-Institut für Bildungsforschung

nachricht High in calories and low in nutrients when adolescents share pictures of food online
07.04.2016 | University of Gothenburg

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: New 3-D wiring technique brings scalable quantum computers closer to reality

Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.

"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...

Im Focus: Scientists develop a semiconductor nanocomposite material that moves in response to light

In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.

A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...

Im Focus: Diamonds aren't forever: Sandia, Harvard team create first quantum computer bridge

By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.

"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...

Im Focus: New Products - Highlights of COMPAMED 2016

COMPAMED has become the leading international marketplace for suppliers of medical manufacturing. The trade fair, which takes place every November and is co-located to MEDICA in Dusseldorf, has been steadily growing over the past years and shows that medical technology remains a rapidly growing market.

In 2016, the joint pavilion by the IVAM Microtechnology Network, the Product Market “High-tech for Medical Devices”, will be located in Hall 8a again and will...

Im Focus: Ultra-thin ferroelectric material for next-generation electronics

'Ferroelectric' materials can switch between different states of electrical polarization in response to an external electric field. This flexibility means they show promise for many applications, for example in electronic devices and computer memory. Current ferroelectric materials are highly valued for their thermal and chemical stability and rapid electro-mechanical responses, but creating a material that is scalable down to the tiny sizes needed for technologies like silicon-based semiconductors (Si-based CMOS) has proven challenging.

Now, Hiroshi Funakubo and co-workers at the Tokyo Institute of Technology, in collaboration with researchers across Japan, have conducted experiments to...

All Focus news of the innovation-report >>>



Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

Agricultural Trade Developments and Potentials in Central Asia and the South Caucasus

14.10.2016 | Event News

World Health Summit – Day Three: A Call to Action

12.10.2016 | Event News

Latest News

Resolving the mystery of preeclampsia

21.10.2016 | Health and Medicine

Stanford researchers create new special-purpose computer that may someday save us billions

21.10.2016 | Information Technology

From ancient fossils to future cars

21.10.2016 | Materials Sciences

More VideoLinks >>>