Ellis M S
Otolaryngology-Head & Neck Surgery at LSU School of Medicine in New Orleans, USA.
J La State Med Soc. 1997 May;149(5):151-8.
The explosive growth in Managed Care Organizations as a mechanism for providing health care in the United States has generated an equal explosion in litigation and new legislation related to problems within this delivery system. Abuses have included the "gagging" of physicians from providing full disclosure of medical options for their patients, inappropriate denial of care, denial of specialty referral, false claims data, insurer insolvency, economic credentialling, deselection, financial disincentives to render care, and lack of appeal or grievance mechanisms. These issues and others have resulted in injuries to patients and damage to the patient/physician relationship. This article discusses some of the more dramatic litigated cases and endeavors to alert both physicians and patients to potential legal matters that should be considered before becoming involved within this structure.
作为美国提供医疗保健的一种机制，管理式医疗组织的迅猛发展引发了与之相关的诉讼和新立法的激增，这些诉讼和立法涉及该医疗服务体系内部的问题。滥用行为包括限制医生向患者充分披露医疗选择、不当拒绝治疗、拒绝专科转诊、虚假索赔数据、保险公司破产、经济资格审查、取消选定资格、提供医疗服务的经济激励不足以及缺乏上诉或申诉机制。这些问题以及其他问题已导致患者受到伤害，并损害了患者与医生之间的关系。本文讨论了一些较为引人注目的诉讼案件，并努力提醒医生和患者注意在参与这一体系之前应考虑的潜在法律问题。
