Nevers A H
Saint Louis University School of Law, USA.
J Health Law. 2000 Spring;33(2):287-354.
Managed care incentives to reduce costs have also resulted in incentives to deny care. Anecdotes concerning managed care denials of care have led to a consumer outcry for protection either through the use of procedural due process or by the establishment of patient rights that would include appeal and grievance protections. This Article reviews the procedural protections of constitutional due process, the Consumer Due Process Protocol, and the Patient Bill of Rights. The Article then extensively discusses the availability of these procedural protections in various public and private forums. The discussion of public forums includes proposals contained in recent national legislative initiatives. The author then reviews relevant federal and state law, as well as Uniform Law proposals. Next, the Article analyzes the protections provided by accreditation agencies, dispute resolution organizations, professional organizations, and health insurers. Finally, the author recommends criteria to be used to determine whether a procedure is fundamentally fair.
管理式医疗降低成本的激励措施也导致了拒绝提供医疗服务的激励。有关管理式医疗拒绝提供医疗服务的传闻引发了消费者的强烈抗议，他们要求通过程序正当程序或确立包括上诉和申诉保护在内的患者权利来获得保护。本文回顾了宪法正当程序的程序保护、消费者正当程序协议和患者权利法案。然后，本文广泛讨论了这些程序保护在各种公共和私人论坛中的可用性。对公共论坛的讨论包括最近国家立法倡议中包含的提案。作者随后回顾了相关的联邦和州法律以及统一法律提案。接下来，本文分析了认证机构、争议解决组织、专业组织和健康保险公司提供的保护。最后，作者推荐了用于确定程序是否基本公平的标准。
