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- Title
ERISA litigation and physician autonomy.
- Authors
Jacobson, Peter D.; Pomfret, Scott D.; Jacobson, P D; Pomfret, S D
- Abstract
The Employee Retirement Income Security Act (ERISA), enacted in 1974 to regulate pension and health benefit plans, is a complex statute that dominates the managed care environment. Physicians must understand ERISA's role in the relationship between themselves and managed care organizations (MCOs), including how it can influence clinical decision making and physician autonomy. This article describes ERISA's central provisions and how ERISA influences health care delivery in MCOs. We analyze ERISA litigation trends in 4 areas: professional liability, utilization management, state legislative initiatives, and compensation arrangements. This analysis demonstrates how courts have interpreted ERISA to limit physician autonomy and subordinate clinical decision making to MCOs' cost containment decisions. Physicians should support efforts to amend ERISA, thus allowing greater state regulatory oversight of MCOs and permitting courts to hold MCOs accountable for their role in medical decision making.
- Subjects
UNITED States; MANAGED care programs; LEGAL liability; LEGAL status of general practitioners; MANAGED care plan laws; MEDICAL care laws; MEDICAL care standards; COMPARATIVE studies; HEALTH services accessibility; LIBERTY; MALPRACTICE; RESEARCH methodology; UTILIZATION review (Medical care); MEDICAL cooperation; PHYSICIANS; RESEARCH; STATE governments; OCCUPATIONAL roles; EVALUATION research; EMPLOYEE Retirement Income Security Act of 1974; LAW; LEGISLATION
- Publication
JAMA: Journal of the American Medical Association, 2000, Vol 283, Issue 7, p921
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.283.7.921