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Journal Article

Reevaluating Reports of Defensive Medicine

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Katherine Baicker, Bill J. Wright, Nicole A. Olson
J Health Polit Policy Law (2015) 40 (6): 1157–1177.
DOI: https://doi.org/10.1215/03616878-3424462
Published: 01 December 2015
... physicians respond to liability pressures by prescribing medically unnecessary care. Many estimates of this relationship are based on physician reports. We present new survey evidence on physician assessment of their own use of medically unnecessary care in response to medical liability and other pressures...
View articletitled, Reevaluating Reports of Defensive Medicine View PDF for article titled, Reevaluating Reports of Defensive Medicine
Includes: Supplementary data
Journal Article

False Claims Act Liability for Overtreatment

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David Howard
J Health Polit Policy Law (2020) 45 (3): 419–437.
DOI: https://doi.org/10.1215/03616878-8161036
Published: 01 June 2020
...David Howard Abstract Context: Overtreatment is costly, but is it fraud? In a growing number of False Claims Act cases, the Department of Justice has sought and received multimillion dollar settlements from providers accused of billing Medicare for unnecessary care. This article evaluates the use...
FIGURES
View articletitled, False Claims Act Liability for Overtreatment View PDF for article titled, False Claims Act Liability for Overtreatment
Journal Article

Overutilization, Overutilized

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Deborah Levine, Jessica Mulligan
J Health Polit Policy Law (2015) 40 (2): 421–437.
DOI: https://doi.org/10.1215/03616878-2882281
Published: 01 April 2015
...Deborah Levine; Jessica Mulligan Abstract Overutilization is commonly blamed for escalating costs, compromising quality, and limiting access to the US health care system. Recent estimates suggest that nearly one-third of health care spending in the United States is a result of unnecessary care...
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Journal Article

When a Solution Is Not a Solution: Medicaid and Health Maintenance Organizations

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Bruce Spitz
J Health Polit Policy Law (1979) 3 (4): 497–518.
DOI: https://doi.org/10.1215/03616878-3-4-497
Published: 01 August 1979
... to accurately budget program expenditures, simplify management, eliminate abusive practices directly linked to fee-for-service (e.g., billing for undelivered services or providing unnecessary care) and, most important, contain costs. At the same time it has promised to increase access to mainstream medicine...
View articletitled, When a Solution Is Not a Solution: Medicaid and Health Maintenance Organizations View PDF for article titled, When a Solution Is Not a Solution: Medicaid and Health Maintenance Organizations
Journal Article

Practice Guidelines and Malpractice Litigation: Collision or Cohesion?

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Troyen A. Brennan
J Health Polit Policy Law (1991) 16 (1): 67–85.
DOI: https://doi.org/10.1215/03616878-16-1-67
Published: 01 February 1991
...Troyen A. Brennan Practice guidelines are standardized specifications for managing particular clinical problems and are intended to improve the outcomes of medical care by increasing adherence to standards of care. They are also meant to make medicine more cost-effective by eliminating unnecessary...
View articletitled, Practice Guidelines and Malpractice Litigation: Collision or Cohesion? View PDF for article titled, Practice Guidelines and Malpractice Litigation: Collision or Cohesion?
Journal Article

Accountable Care Organizations in California: Market Forces at Work?

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Christopher Whaley, H. E. Frech, III, Richard M. Scheffler
J Health Polit Policy Law (2015) 40 (4): 689–703.
DOI: https://doi.org/10.1215/03616878-3150000
Published: 01 August 2015
...Christopher Whaley; H. E. Frech, III; Richard M. Scheffler Abstract Accountable care organizations (ACOs), one of the most recent and promising health care delivery innovations, encourage care coordination among providers. While ACOs hold promise for decreasing costs by reducing unnecessary...
FIGURES
View articletitled, Accountable <span class="search-highlight">Care</span> Organizations in California: Market Forces at Work? View PDF for article titled, Accountable <span class="search-highlight">Care</span> Organizations in California: Market Forces at Work?
Journal Article

Using the Courts to Shape Medicaid Policy: Olmstead V. L.c. by Zimring and Its Community Integration Legacy

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Sara Rosenbaum
J Health Polit Policy Law (2016) 41 (4): 585–597.
DOI: https://doi.org/10.1215/03616878-3620833
Published: 01 August 2016
... are protected by the ADA have the right to receive publicly funded services in community-integrated treatment settings and that medically unnecessary institutionalization violates the ADA. But the Court had to wrestle with the extent to which the ADA requires state Medicaid programs to make deep and structural...
View articletitled, Using the Courts to Shape Medicaid Policy: Olmstead V. L.c. by Zimring and Its Community Integration Legacy View PDF for article titled, Using the Courts to Shape Medicaid Policy: Olmstead V. L.c. by Zimring and Its Community Integration Legacy
Journal Article

The Cost and Value of Second Surgical Opinion Programs: A Critical Review of the Literature

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Phoebe A. Lindsey, Joseph P. Newhouse
J Health Polit Policy Law (1990) 15 (3): 543–570.
DOI: https://doi.org/10.1215/03616878-15-3-543
Published: 01 June 1990
.... U.S. Congress, House Committee on Interstate and Foreign Commerce, Subcommittee on Oversight and Investigations. 1967 . Cost and Quality of Health Care: Unnecessary Surgery. 94th Cong., 2d sess. The Cost and Value of Second Surgical Opinion Programs: A Critical...
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Journal Article

Children's Advocacy and Primary Health Care

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Richard F. Tompkins
J Health Polit Policy Law (1979) 3 (4): 519–554.
DOI: https://doi.org/10.1215/03616878-3-4-519
Published: 01 August 1979
... which the decision is made. Children as a class are not well served by the health sector relative to other groups; poor children receive benefits and bear costs unequal to the nonpoor; and there is an unnecessary gap between what our technology is capable of offering and what is actually provided...
View articletitled, Children&#x27;s Advocacy and Primary Health <span class="search-highlight">Care</span> View PDF for article titled, Children&#x27;s Advocacy and Primary Health <span class="search-highlight">Care</span>
Journal Article

The United States: Breakthroughs and Waste

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Uwe E. Reinhardt
J Health Polit Policy Law (1992) 17 (4): 637–666.
DOI: https://doi.org/10.1215/03616878-17-4-637
Published: 01 August 1992
.... Experts in health policy point to the widespread excess capacity en- gendered by the nation’s laissez-faire, entrepreneurial approach to health care and to the frequency with which that excess capacity appears to lead to the application of medically unnecessary procedures to patients...
View articletitled, The United States: Breakthroughs and Waste View PDF for article titled, The United States: Breakthroughs and Waste
Journal Article

It's Time to Fund Physician Shortage Programs by Abandoning Unrestricted State Subsidies to Medical Schools

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Bill Bernstein, Barry Ensminger
J Health Polit Policy Law (1983) 8 (2): 221–234.
DOI: https://doi.org/10.1215/03616878-8-2-221
Published: 01 April 1983
... directly to support physician shortage and minority recruitment programs. This article argues that unrestricted subsidies are inequitable, wasteful, unnecessary, and inflationary; therefore they should be abandoned, in favor of programs that contribute directly to the supply of primary care physicians...
View articletitled, It's Time to Fund Physician Shortage Programs by Abandoning Unrestricted State Subsidies to Medical Schools View PDF for article titled, It's Time to Fund Physician Shortage Programs by Abandoning Unrestricted State Subsidies to Medical Schools
Journal Article

Legal Issues Raised by Private Review Activities of Medical Peer-Review Organizations

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Douglas A. Hastings
J Health Polit Policy Law (1983) 8 (2): 293–313.
DOI: https://doi.org/10.1215/03616878-8-2-293
Published: 01 April 1983
... organizations to take in order to avoid unnecessary legal problems. Because of the increasing involvement of medical peer-review organizations in private review contracts with health care insurers, it is important to consider the legal issues raised by such contracts. “Private review” is the name com...
View articletitled, Legal Issues Raised by Private Review Activities of Medical Peer-Review Organizations View PDF for article titled, Legal Issues Raised by Private Review Activities of Medical Peer-Review Organizations
Journal Article

Legal, Imagined, and Real Worlds: Reflections on National Federation of Independent Business V. Sebelius

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Jerry L. Mashaw
J Health Polit Policy Law (2013) 38 (2): 255–266.
DOI: https://doi.org/10.1215/03616878-1966243
Published: 01 April 2013
...Jerry L. Mashaw Chief Justice John Roberts's opinion upholding the individual mandate in the Patient Protection and Affordable Care Act has been hailed as an act of judicial statesmanship that saved the Supreme Court from serious criticism as a partisan, political institution. This article argues...
View articletitled, Legal, Imagined, and Real Worlds: Reflections on National Federation of Independent Business V. Sebelius View PDF for article titled, Legal, Imagined, and Real Worlds: Reflections on National Federation of Independent Business V. Sebelius
Journal Article

How Will We Use Clinical Guidelines? The Experience of Medicare Carriers

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Colleen M. Grogan, Roger D. Feldman, John A. Nyman, Janet Shapiro
J Health Polit Policy Law (1994) 19 (1): 7–26.
DOI: https://doi.org/10.1215/03616878-19-1-7
Published: 01 February 1994
...' medical review rhetoric- using the terms medically unnecessary andfraud and abuse as synonyms-also high- lights their focus on cost control and the lack of concern about why services are used inappropriately. While disagreement over the structure of the U.S. health care system is commonplace...
View articletitled, How Will We Use Clinical Guidelines? The Experience of Medicare Carriers View PDF for article titled, How Will We Use Clinical Guidelines? The Experience of Medicare Carriers
Journal Article

Editor's Note

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Colleen M. Grogan
J Health Polit Policy Law (2015) 40 (6): 1113–1114.
DOI: https://doi.org/10.1215/03616878-3424438
Published: 01 December 2015
... spending. In “Reevaluating Reports of Defensive Medicine,” Katherine Baicker, Bill Wright, and Nicole Olson note that the effectiveness of such policy levers often depends on how physicians respond to information regarding medically unnecessary care. In light of this, the authors conduct physician surveys...
View articletitled, Editor's Note View PDF for article titled, Editor's Note
Journal Article

The Future of Health Policy

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Lloyd M. Krieger
J Health Polit Policy Law (1994) 19 (4): 914–916.
DOI: https://doi.org/10.1215/03616878-19-4-914
Published: 01 August 1994
... reasons to try to contain costs. He notes that both economic theory and empirical research show that many current health care services do not provide benefits commensurate with their costs. Defensive medicine and unnecessary care are clear examples. Fuchs also outlines the more subtle case of care...
View articletitled, The Future of Health Policy View PDF for article titled, The Future of Health Policy
Journal Article

Who Was That Straw Man Anyway? A Comment on Evans and Rice

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Mark V. Pauly
J Health Polit Policy Law (1997) 22 (2): 467–473.
DOI: https://doi.org/10.1215/03616878-22-2-467
Published: 01 April 1997
... of economists who have done so much to explore how markets might solve resource allocation problems in med- ical care. It is obviously both presumptuous and unnecessary for me personally to defend these scholars from the Evans-Rice critique—for many reasons, they need no defense and are perfectly capable...
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Journal Article

Hypotheses and Hope: Policy Analysis and Cost Controls (or Not) in the Affordable Care Act

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Joseph White
J Health Polit Policy Law (2018) 43 (3): 455–482.
DOI: https://doi.org/10.1215/03616878-4366184
Published: 01 June 2018
... and population totals, rather than individual experience, may be even more problematic for policies about reducing “unnecessary” care. When he addressed cost control in public meetings, President Obama proclaimed, “That's not rationing, it's being sensible” (quoted in Nather 2009 ). But what looks sensible...
View articletitled, Hypotheses and Hope: Policy Analysis and Cost Controls (or Not) in the Affordable <span class="search-highlight">Care</span> Act View PDF for article titled, Hypotheses and Hope: Policy Analysis and Cost Controls (or Not) in the Affordable <span class="search-highlight">Care</span> Act
Journal Article

Hospital Utilization Review: Past Experience, Future Directions

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Danny Ermann
J Health Polit Policy Law (1988) 13 (4): 683–704.
DOI: https://doi.org/10.1215/03616878-13-4-683
Published: 01 August 1988
.... C. , and E. O'Brien. 1987 . Keying Review Efforts to Geographic Variations. Business and Health 5 ( 1 ): 38 -42. Donahue , R. 1987 . Unnecessary Health Care Wastes $100 Billion. Medical Benefits 4 ( 6 ): 2 . Dragalin , D. 1987 . Prudential Was First [letter to editor...
View articletitled, Hospital Utilization Review: Past Experience, Future Directions View PDF for article titled, Hospital Utilization Review: Past Experience, Future Directions
Journal Article

Do We Really Want to Control Health Care Spending?

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Michael K. Gusmano
J Health Polit Policy Law (2011) 36 (3): 495–500.
DOI: https://doi.org/10.1215/03616878-1271153
Published: 01 June 2011
... that such cost sharing is as likely to discourage the consumption of beneficial health care as it is “unnecessary” health care (Marmor 2010).1 Investments in comparative effectiveness research (CER) are supposed to eliminate “unnecessary” care, saving billions while improving quality (Fisher, Bynum...
View articletitled, Do We Really Want to Control Health <span class="search-highlight">Care</span> Spending? View PDF for article titled, Do We Really Want to Control Health <span class="search-highlight">Care</span> Spending?