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The Challenge of Regulating Managed Care
John E. Billi and Gail B. Agrawal, Editors
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Representatives of industry, government, caregivers, and consumers join scholars and policy analysts in comparing market forces to regulation as potential means for righting what is wrong with managed care. The contributors that John E. Billi and Gail B. Agrawal have gathered here quickly move the healthcare debate beyond the classroom, think tank, and statehouse to the boardroom and examining room.
Some argue strongly that the solution is to be found in the democratic process and government intervention, while others maintain that only market forces in a competitive environment can respond quickly to the needs of consumers and purchasers alike. The contributors' diverse opinions about the oversight of managed care reflect an enduring divide, one that will affect how society ultimately resolves questions about the inevitable tradeoffs among health-care quality, cost, and access in an environment of limited resources.
The Challenge of Regulating Managed Care will appeal to policymakers, those in the medical field, and all readers interested in the American experience with managed care.
John E. Billi is Associate Professor of Internal Medicine and Medical Education; Associate Dean for Clinical Affairs, University of Michigan Medical School; and Associate Vice President for Medical Affairs, University of Michigan.
Gail B. Agrawal is Associate Professor of Law, University of North Carolina, Chapel Hill.
Some argue strongly that the solution is to be found in the democratic process and government intervention, while others maintain that only market forces in a competitive environment can respond quickly to the needs of consumers and purchasers alike. The contributors' diverse opinions about the oversight of managed care reflect an enduring divide, one that will affect how society ultimately resolves questions about the inevitable tradeoffs among health-care quality, cost, and access in an environment of limited resources.
The Challenge of Regulating Managed Care will appeal to policymakers, those in the medical field, and all readers interested in the American experience with managed care.
John E. Billi is Associate Professor of Internal Medicine and Medical Education; Associate Dean for Clinical Affairs, University of Michigan Medical School; and Associate Vice President for Medical Affairs, University of Michigan.
Gail B. Agrawal is Associate Professor of Law, University of North Carolina, Chapel Hill.
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Cover
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Title
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Copyright
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Contents
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Acknowledgments
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Part 1. Understanding the Big Picture
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1. Managing the Managers: An Introduction to the Challenge of Overseeing Managed Care
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2. A National Overview
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3. The Stages of Managed-Care Regulation: Developing Better Rules
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Part 2. Views from the Trenches: Patients and Providers
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4. A Physician's View from the Trenches
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5. A Consumer Advocate's View from the Trenches
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6. Oversight of Managed Care: An Academic Health Center Perspective
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Part 3. Purchasers and Market Oversight
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7. Markets for Medicine?
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8. General Motors as Purchaser
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9. Medicaid: The Prudent Purchaser
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10. NCQA: Using Market Pressure to Promote Quality in Managed Care
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11. The American Association of Health Plans: Representing the Industry
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Part 4. The Role of Regulation and Litigation
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12. The Role of State Insurance Regulators
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13. The Role of Private Litigation in Monitoring Managed Care
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Appendix A: Glossary of Terms and Acronyms
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Appendix B: Managed Care On-line Resources
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List of Contributors
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Index
Citable Link
Published: 2001
Publisher: University of Michigan Press
- 978-0-472-09778-4 (hardcover)
- 978-0-472-02372-1 (ebook)