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Health Affairs, Vol 16, Issue 6, 7-21
Copyright © 1997 by Project HOPE

Journal Article

Federal regulation of managed care: an impulse in search of a theory?

Although there is growing demand for regulation of the managed care industry, regulatory proponents have yet to articulate a clear theory of regulation. Most observers acknowledge consumer information problems that regulation could address, but there is no consensus regarding regulation of the broader public concern about restrictive medical-necessity determinations by health plans. Concerns about these issues--which fall within the gray areas of divergent clinical opinion--may be difficult or impossible to address by explicit regulation. If policymakers forbear on regulation of medical-necessity determinations, private market innovation may ultimately remedy this problem.

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