Regulating Managed Care : Theory, Practice, and Future Options

From The Critics

Reviewer: Bryan E. Dowd, PhD(University of Minnesota School of Public Health)
Description: This is a collection of essays on regulating the health insurance industry, with special emphasis on health maintenance organizations (HMOs). The essays are written by academics and representatives of consumers and industry.
Purpose: Papers from a 1988 conference on regulatory reforms in the health insurance industry are presented. Regulation of the health insurance industry is an important topic, particularly with the introduction of HMOs, which often are treated differently from traditional insurance companies under federal and state laws. Currently, interest in HMO regulation has been heightened by the various ways that HMOs have intervened in the patient-provider relationship.
Audience: The conference on which the book is based was targeted towards national health policy experts. The book is written for a general audience of academics and their students, and industry and consumer representatives. The authors of the chapters are all credible authorities in the subject matter of the book.
Features: The theory of regulation, the ways in which the HMO industry does and does not fit the standard model, consumer and insurance industry perspectives on regulation and practical implementation issues are all covered. Pauly and Berger provide an interesting and original analysis of consumer dissatisfaction with managed care and possible links to the tax treatment of health insurance. A severe deficiency of the book is that despite the claims by the industry that HMOs already are heavily regulated, none of the editor or contributors, to my knowledge, currently is engaged in the regulation of managed care.
Assessment: This book provides a very useful and unique collection of essays by some of the nation's most influential health policy experts. The essays generally are of good quality, though most of the industry perspectives simply toe the "party line" and add no new information. The book would be a good choice for a health policy course on regulation, but would need to be accompanied by a good economic text on the general theory of regulation. The introductory chapter by Altman and Rosman is inadequate in that regard, as they actually confuse the issue by portraying regulatory interventions as "philosophies," rather than specific approaches indicated by objective analysis of market failure.

Bryan E. Dowd

This is a collection of essays on regulating the health insurance industry, with special emphasis on health maintenance organizations (HMOs). The essays are written by academics and representatives of consumers and industry. Papers from a 1988 conference on regulatory reforms in the health insurance industry are presented. Regulation of the health insurance industry is an important topic, particularly with the introduction of HMOs, which often are treated differently from traditional insurance companies under federal and state laws. Currently, interest in HMO regulation has been heightened by the various ways that HMOs have intervened in the patient-provider relationship. The conference on which the book is based was targeted towards national health policy experts. The book is written for a general audience of academics and their students, and industry and consumer representatives. The authors of the chapters are all credible authorities in the subject matter of the book. The theory of regulation, the ways in which the HMO industry does and does not fit the standard model, consumer and insurance industry perspectives on regulation and practical implementation issues are all covered. Pauly and Berger provide an interesting and original analysis of consumer dissatisfaction with managed care and possible links to the tax treatment of health insurance. A severe deficiency of the book is that despite the claims by the industry that HMOs already are heavily regulated, none of the editor or contributors, to my knowledge, currently is engaged in the regulation of managed care. This book provides a very useful and unique collection of essays by some of the nation's most influential healthpolicy experts. The essays generally are of good quality, though most of the industry perspectives simply toe the ""party line"" and add no new information. The book would be a good choice for a health policy course on regulation, but would need to be accompanied by a good economic text on the general theory of regulation. The introductory chapter by Altman and Rosman is inadequate in that regard, as they actually confuse the issue by portraying regulatory interventions as ""philosophies,"" rather than specific approaches indicated by objective analysis of market failure.

Booknews

Penned by academics specializing in health policy, CEOs of insurance companies, presidents of research foundations, and others, these 19 contributions offer a variety of political perspectives on government regulation of health care in America. The majority of the articles seem to favor a market-oriented system, but differing degrees of regulation are recommended, including long-term care ombudsman programs, quality control, and expanded liability. Also included are articles discussing broader, more theoretical issues. Annotation c. Book News, Inc., Portland, OR (booknews.com)

3 Stars from Doody