The death of managed care: a regulatory autopsy

On the heels of widespread patient protection legislation in the states, the managed care industry abandoned or greatly scaled back the core elements of gate-keeping, utilization management, and financial incentives, which are the very targets of this legislation. This article explores whether, and to what extent, the industry's abrupt change in course can be attributed to these laws. Based on extensive interviews with key informants in six representative states, the article concludes that these laws were not the primary driver of changes in managed care practices. However, patient protection laws interacted with other social and market forces, through complex forms of feedback and reinforcement, to bring about more thoroughgoing change than would have otherwise occurred.     

The place of law in a business studies curriculum

Abstract

LEGAL ETHICS are the values that inform the practice of law. This article establishes what and how Australian law schools teach about legal ethics and suggests what and how Australian law schools should teach about legal ethics.

First, the article establishes that Australian law schools tend to teach legal ethics as if it were only concerned with the law of lawyering. It also establishes that Australian law schools tend to teach legal ethics discretely over the course of one subject out of the whole undergraduate curriculum.

Secondly, this article suggests the adoption of a new approach to legal ethics as the ability to exercise legal ethical judgment. It also suggests a pervasive method of instruction that integrates issues of legal ethics and the process of legal ethical judgment into every subject in the undergraduate curriculum in combination with discrete subjects on the context and substance of the law of lawyering.     

The complexities of managed care: operating a voluntary system

The implementation of state-sponsored voluntary case management programs for public assistance recipients creates provider and recipient recruiting problems that are unique to the state's economic environment, its political climate, its historic relationship with providers, its program goals, and its implementation strategies. This implementation study discusses the factors that influenced the operationalization of the Massachusetts managed care program for AFDC families. The issues of provider recruitment and recipient enrollment are examined in relation to the formal program goals of cost containment and access. The operational and bureaucratic problems the state Medicaid staff has experienced in maintaining the program evokes questions of who should administer the programs, who the best types of providers are in light of program goals, and how recipients can be enrolled in a voluntary program.     

The ethics of managed care: a dose of realism

This article examines the ethics of medical practice under managed care from a pragmatic perspective that gives physicians more useful guidance than existing ethical statements. The article begins by stating the authors' starting premises and framework for constructing a realistic set of ethical principles: namely, that bedside rationing in some form is permissible; that medical ethics derive from physicians' role as healers; that actual agreements usually trump hypothetical ones; that ethical statements are primarily aspirational, not regulatory; and that preserving patient trust is the primary objective. The authors then articulate the following concrete ethical guides: financial incentives should influence physicians to maximize the health of the group of patients under their care; physicians should not enter into incentive arrangements that they would be embarrassed to describe accurately to their patients or that are not in common use in the market; physicians should treat each patient impartially, without regard to source of payment, and in a manner consistent with the physician's own treatment style; if physicians depart from this ideal, they must tell their patients honestly; and it is desirable, although not mandatory, to differentiate medical treatment recommendations from insurance coverage decisions by clearly assigning authority over these different roles and by having physicians to advocate for recommended treatment that is not covered.     

The stages of managed care regulation: developing better rules

The managed care industry is at a crossroads. Belief in the ability of market forces alone to create an environment fostering quality health care at lower cost is eroding. Regulators across the country are confronted with a growing consumer backlash against managed care. As a result, states have passed managed care reform legislation at unprecedented rates. In doing so, states are confronted with a patchwork of federal intervention and preemption. We examine the stages of these recent state and federal developments and evaluate them in terms of the traditional objectives of a reasonably functioning health care system: quality care, access, and cost containment.     

The place of law in the leadership and management of schools

Change is a feature of life in all communities and results in heightened demands being made of individuals and organizations alike. In the school setting administrators and classroom teachers have to respond to a great variety of demands that change has brought. Accountability, in various guises, is one area where changes in societal attitudes have resulted in greater demands being exacted of all professions including that of teaching. In this regard legal accountability is of considerable concern to schools as legal matters increasingly impact on school policies, practices and procedures. In this article research into the relationship between the law and school leadership and management is explored. A brief overview of research into school management and principals as leaders is followed by a discussion of the need for knowledge of areas of law impacting on schools. The article concludes that in order to ensure a school's legal safety, a preventive legal risk management culture is needed.     

Family as a commonsensical device and its place in law★

This paper is in five main parts. The first introduces membership categorisation analysis (MCA) as originally outlined by Harvey Sacks and, here, as a possible extension of semiotic analysis. MCA is broadly a contribution to discourse analysis in general and to conversation analysis in particular. The approach concerns membership categorisation devices such as family, the categories they can contain such as ‘mother’, ‘father’, ‘child’, etc. and the category-bound activities or predicates commonsensically attachable to such categories. The second section looks at the legal background to family law in Australia and shows that its basic assumption is, by and large and with some exceptions, to work from categories (what people are) rather than from predicates (what they in fact do). In the third section, we examine a particular Family Court case (Re Patrick) which highlights the contestation between these approaches. Following this, we examine some recent shifts in the Australian states and territories towards more predicationally-based legislation and argue for their coherence in contemporary society and its increasingly flexible conceptions of what may constitute a family. Finally, we return to the question of semiotics generally and make a case for our MCA-based distinctions as contributions to a possible semiotics of law. In the beginning was the deed – Goethe