What you don't know can hurt you: why managed care organizations have a legal duty to disclose the use of financial incentives to limit medical care

This article, winner of the 2000-2001 American Health Lawyers' Student Writing Competition, examines the conflicting policy goals at the heart of managed care--particularly in the use of financial incentives for physicians who limit their use of referrals and expensive diagnostic tests. While conceding the legality of such incentives, the author contends that Managed Care Organizations (MCOs) have a legal duty to disclose their existence to beneficiaries. After analyzing the basis for imposing a duty to disclose, the author proceeds to examine such issues as the proper timing, level, and extent of disclosure.     

Bundaberg and beyond: duty to disclose adverse events to patients

Although much excellent work has been done in Australia and elsewhere to improve the safety and quality of health care provision, the practice of medicine is inherently risky--adverse events sometimes occur. In Australia, practical guidelines for the open disclosure of adverse events to patients have been developed and are being implemented. State and Territory medical boards have recently adopted Codes of Conduct which include disclosure provisions, although the Australian Medical Association's Code of Ethics does not yet contain express patient disclosure provisions. There is a dearth of authority concerning legal obligations to disclose known or suspected adverse events. Although many Australian jurisdictions have introduced statutory protection for those who apologise or express regret to patients following an adverse event, there is no corresponding express statutory disclosure obligation, unlike in some parts of the United States. The Bundaberg experience illustrates the complex ethical, practical and legal issues which arise in this area.