The Managed Care Dilemma: Can Theories of Tort Liability Adapt to the Realities of Cost Containment?
Document Type
Article
Publication Date
1997
Abstract
Over the years, the United States health care system has undergone a transformation from a market comprised mainly of self employed physicians· in solo or small group practices to one in which far fewer physicians engage in this type of independent practice. More than three quarters of the physicians in this country now practice medicine within some form of managed care organization ("MCO") or see some managed care patients. The public increasingly perceives the care provided through MCOs as inferior to traditional feefor-service care. Responding to constituent pressures, legislatures in more than twenty states recently have considered bills regulating managed care practices, and Congress has now taken up the issue. Even some employers who offer access to managed care plans as part of their benefits packages have begun to scrutinize HMOs more closely.
This Article provides a brief description of the different types of managed care organizations and explores the philosophy of managed care, particularly regarding cost containment. Part III canvasses the different theories for imposing liability on MCOs for the effects of costcontainment measures as well as for the malpractice of their physicians. Part IV considers problems associated with the imposition of tort liability, and Part V suggests alternatives to tort liability and explores the ethical implications of reforms that exclude corporate liability altogether. Ultimately, this Article concludes that managed care organizations should receive statutory immunity from malpractice suits so long as government officials meaningfully regulate the delivery of health care services by these entities.
Recommended Citation
48 Mercer L. Rev. 1219 (1997)
