Moran D W
Health Aff (Millwood). 1997 Nov-Dec;16(6):7-21. doi: 10.1377/hlthaff.16.6.7.
Although there is growing demand for regulation of the managed care industry, regulatory proponents have yet to articulate a clear theory of regulation. Most observers acknowledge consumer information problems that regulation could address, but there is no consensus regarding regulation of the broader public concern about restrictive medical-necessity determinations by health plans. Concerns about these issues--which fall within the gray areas of divergent clinical opinion--may be difficult or impossible to address by explicit regulation. If policymakers forbear on regulation of medical-necessity determinations, private market innovation may ultimately remedy this problem.
尽管对管理式医疗行业进行监管的需求不断增长，但监管支持者尚未阐明明确的监管理论。大多数观察家承认监管可以解决的消费者信息问题，但对于监管健康计划更广泛的公众对限制性医疗必要性判定的担忧，尚未达成共识。对这些属于不同临床意见灰色地带的问题的担忧，可能很难或不可能通过明确的监管来解决。如果政策制定者对医疗必要性判定的监管持克制态度，私人市场创新最终可能会解决这个问题。
