Report Outlines Who Should Protect Managed Care Consumers

Study of state-level HMO user legislation

During 1996 and 1997, staff at Kalkines, Arky, Zall & Bernstein produced a report evaluating state legislative initiatives intended to preserve the autonomy of the physician-patient relationship within the new cost and clinical constraints of managed care.

The researchers interviewed approximately 40 stakeholders, including health care providers, managed care executives and consumer activists, and conducted a literature review of legislation, government regulations and industry periodicals.

Kalkines, Arky, Zall & Bernstein was a Manhattan law firm specializing in health care law. It was acquired in 2003 by Los Angeles-based Manatt, Phelps & Phillips.

Key Recommendations

The report, entitled Who Should Protect Managed Care Consumers? recommended that:

  • Government should play a role in promoting full disclosure, procedural fairness and access to essential services, while avoiding interference with market-driven quality improvements.

  • The federal government should establish a consumer protection floor, supplemented and enforced by the states.

  • Government should use its purchasing power to establish consumer-oriented purchasing criteria.

  • It also found an emerging consensus on the general scope of managed care consumer protection legislation among stakeholders with otherwise divergent interests.