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Patient protection laws don't favor health providers

WINSTON-SALEM, N.C. 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 n
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Contact: Karen Richardson
krchrdsn@wfubmc.edu
336-716-4587
Wake Forest University Baptist Medical Center
23-Dec-2004


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