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Managed care vs. Patients' Rights

Discussion in 'Medical Students - DO' started by muonwhiz, Jun 23, 2001.

  1. muonwhiz

    muonwhiz Senior Member

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    It looks like the Senate is trying again to come up with a patients' bill of rights. The question that seems to be at controversy is whether or not that those who make medical decisions that affect coverage should be jointly and severally liable with physicians and their insurers in the event of a fault based bad result. Right now, managed care organizations (MCOs) are protected by law, so they can make all the medical decisions they want and if it goes badly, then the physician is the only one left holding the bag. Also, the question is whether or not employers should have liability if they make decisions that delay or deny care causing injury or death to the patient. One position (favored by Republicans) is that if employers become liable (even if they do make these decisions) then they will simply stop offering health benefits to employees. Another position (favored by Democrats) is that employers who make these decisions must also share liability for them, becuase if they are exempt the MCO's will just transfer those decisions to exempt employers. If this is the case, (and employers are exempt) then physicians will still be the only ones left in liability - which seems manifestly unfair, since physicians are losing their medical decision making authority. What do you think?
     
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  3. ericmonty

    ericmonty Junior Member

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    I don't really know about the issue where liablity will fall with the two different versions of the Patient's Bill of Rights. However, I favor Republican version. As I understand it, the republican version would require any disputes over coverage to go before a medical review committee, which would decide whether or not the treatment is waranted and if the HMO should be held accountable. Thus if the committee feels that the treatment is necessary and falls within the coverage the patient has, the HMO should cover it. If the HMO still denies coverage THEN THE PATIENT CAN SUE. The democratic version apparently skips the medical review, taking medical decisions out of the hands of physicians, and sends the case directly to litigation. Also the republican version caps monetary rewards, but the democratic version does not. I think capping rewards is important. If someone is wronged by in a particular situation by an HMO, then the HMO should be held accountable and have to pay. A reward of 10 or 20 million dollars should be sufficient for any infraction, but rewards in the Billions (which are getting more common these days) are execessive for a single settlement. And who makes most of that money? LAWYERS - with contingency fees of 30, 40, or 50%. Huge settlements will drive the cost of HMO coverage up, as the HMOs will not absorb these costs, and will pass them on to employers and employees. I think the republican version favors keeping medical decisions in the hands of medical professionals and keeps the costs down. Versus the democratic version which takes medical decisions out of the hands of medical professionals, while driving up costs due to unilimited (uncapped) monetary reward, and encouraging lawsuits by not having an intermediary phase of medical review (or even HMO internal review) - instead allowing the case to go directly to court and litigation. You better believe that trial lawyers are licking their chops. Lawyers and unscrupulous people who bring frivolous lawsuits will benefit if the democratic version passes unamended, and the rest of the insured population will pay for it in higher premiums or loss of coverage because they can't afford it. :rolleyes: ERIC
     

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