justice) and their application in making wise decision. But, just having the detailed document on patient’s rights will not help, and the continuing education, monitoring, and other strict administrative actions are needed to be ensured as patient-centered ethics (Morrison, 2011). Reference: Morrison, E. E. (2011). Ethics in health administration (2nd ed.). Sudbury, MA: Michael Brown. SUNDAY BOOK: Contemporary Issues in Healthcare Law and Ethics. CHAP: 14 Selective Contracting Managed care has changed the way healthcare and healthcare providers work for patients and also the way patients chooses their healthcare providers. Selective contracting is one of the way to control healthcare costs and managed care. There are many third party payers who works with preferred healthcare providers that are willingly cut their prices to
acquire large number of patients. The bidding of preferred provider contracts has improved the level of competition in the healthcare industry. After managed care was introduced into the healthcare industry, patients were not allowed to choose healthcare providers. They started having options for healthcare providers that they need to choose from. Before managed care programs, the concept of free choice of provider allowed patients to choose their choice of healthcare provider (doctor or hospital) to receive treatments. Patients were choosing expensive healthcare providers which was putting pressure on health insurance companies as they were responsible for pay the bills and this practice known to increase the healthcare costs. To control this increasing healthcare costs, people and organizations found a way to deal with it by finding the concept of selective contracting with particular providers. In the selective contracting, payers enter into the contracts with providers that are not expensive and provides discounts, and also agree on payer’s utilization evaluation measures. The physicians and healthcare facilities increases their market share by reducing the process for healthcare services and by becoming preferred providers for payers. State legislature have implemented so many laws that terminates healthcare provider contract. The main purpose of the state laws is to preclude payers from dismissing physicians in retribution for encouraging for the needs of their patients (Harris, 2007). Reference: Harris, D.M. (2007). Contemporary issues in healthcare law and ethics (3 rd ed.). Chicago, IL: Health Administration Press. CHAP: 16 Federal ERISA Law The Federal Employee Retirement Income Security Act (ERISA) of 1974 resulted into limiting the right of patients in HMOs and third party payers while, it was envisioned to defend the interest of employees and patients. ERISA was enacted before the implementation of the managed care and it can result in very unfair way when applied to the system of managed care. The ERISA was enacted in 1974 to provide protection to the rights of employees with regards to the pension and other benefits i.e. health insurance.
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