What is confusing or surprising about the article "The Role of the Courts in Shaping Health Policy: An Empirical Analysis" by Peter D. Jacobson, Elizabeth Selvin, and Scott D. Pomfret?

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mrkirschner | High School Teacher | (Level 3) Associate Educator

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Surprising:

  • Doctors may receive bonuses if they keep costs down, but then they also may be found liable for denying care.

  • The stakes are high in health care coverage cases.  If they rule heavily in favor of MCOs, individual rights and liberties may be infringed, but if courts rule in favor of the individual patients they risk damaging the health care system by having the system become too expensive.

  • It's surprising the quantitative research analysis of the legal system is not a common methodology.  Since every case is different, with a completely different cast of players (lawyers, judges, defendants and plaintiffs), is empirical analysis even worthwhile? (This could be considered confusing as well.)

  • It seems the courts lean toward controlling costs more than they did in the fee for service era.  When cost controls were given even limited weight in the decision, defendants won a majority of the time.

  • The courts are uncharacteristically giving significant weight to how their decisions will affect policy making decisions.

  • The courts have not granted health care “special case” status (the idea that healthcare is "different" and seem to have a desire to not intervene with the transformation to managed care).  Courts have seemed to protect and promote this transformation.

Confusion:

  • When you consider that the judicial court system is usually most interested in individual liberties and rights, it is hard to believe that the courts have ruled in favor of MCOs (defendants) 51% of the time and the individual plaintiffs 41%.
  • Why did courts not rule in favor of plaintiffs when justice/fairness was only given limited weight in the decision?  It would seem that the courts are established to make fair and just decisions, but when limited weight was given in this area, they ruled in favor of the defendants.  When cost considerations were given only limited weight, courts ruled in favor of MCOs.

  • Does the marginalization of physicians by the courts have an adverse effect on patient care and is this something that the courts should take into account in future decisions?

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