Improving Dispute Resolution in Health Care

改善医疗保健领域的争议解决

• 批准号: 6318152
• 负责人: DAVID M STUDDERT
• 金额: $ 8.07万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-30 至 2004-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6318152
• 关键词: Medicare /Medicaid; decision making; health care policy; health care quality; health insurance; health related legal; health science research analysis /evaluation; health services research tag; managed care

My training in law and health services research has led to interests in health law, health policy and medical ethics. Research to date has focused on medical malpractice. More recently, however, my interests have gravitated toward legal issues in medical error and Disputes in health care. The agenda outlined in this proposal relates to the latter. It is premised on the overarching hypothesis that advancement of knowledge about disputes in health care-in particular, information about why they arise, how they are resolved, and the identity of the disputants- will help guide policy and practice toward three positive outcomes: (1) improved quality of care; (2) greater procedural justice and fairness for managed care enrollees; and (3) reduced costs. Two projects will occupy the majority of my time over the next four years. The first, a study of coverage decision-making in managed care organizations, began in October, 1999. Its goal is to describe and analyze denials of insurance coverage within a managed care population, with a particular focus on how vulnerable enrollees (e.g. the poor, minorities, those lacking physician support for their claim) fare in appealing coverage decisions. Data for the project come from two large health plans and two medical groups in California. The second study has training similar goals but is centered on external review of coverage appeals, specifically among Medicare beneficiaries in managed care. With collaborators at the Center for Health Dispute Resolution, the largest external reviewer in the country, we are currently developing a proposal. As well as providing opportunities to pursue a range of exciting normative and descriptive research questions related to the above studies, the proposed award would allow me the time and flexibility to develop my career in several key areas: (1) quantitative and qualitative skills relevant to empirical research in health law; (2) grant-writing experience; (3) capacity to pursue policy-relevant analyses from existing data sources; and (4) successful transition into a new, little-studied area of health policy.

我在法律和卫生服务研究方面的培训使我对卫生法、卫生政策和医学伦理产生了兴趣。迄今为止的研究主要集中在医疗事故上。 然而，最近我的兴趣转向了医疗错误和医疗保健纠纷中的法律问题。 本提案中概述的议程与后者有关。 它的前提是一个总体假设，即有关医疗保健纠纷的知识的进步，特别是有关纠纷产生原因、解决方式以及纠纷者身份的信息，将有助于指导政策和实践取得三个积极成果：(1) 提高护理质量； (2) 为管理式医疗参与者提供更大的程序公正和公平； (3)降低成本。在接下来的四年里，有两个项目将占据我的大部分时间。 第一项研究于 1999 年 10 月开始，针对管理式医疗组织的承保决策进行研究。其目标是描述和分析管理式医疗人群中拒绝承保的情况，特别关注弱势参保者（例如穷人、少数族裔、缺乏医生支持其索赔的人）在上诉承保决策中的表现。 该项目的数据来自加利福尼亚州的两个大型健康计划和两个医疗团体。 第二项研究具有类似的培训目标，但重点是对承保上诉的外部审查，特别是管理式医疗中的医疗保险受益人。 我们目前正在与该国最大的外部审查机构健康纠纷解决中心的合作者制定一项提案。除了提供机会去追求与上述研究相关的一系列令人兴奋的规范性和描述性研究问题外，拟议的奖项还将使我有时间和灵活性在几个关键领域发展我的职业生涯：（1）与卫生法实证研究相关的定量和定性技能； (2) 资助项目撰写经验； (3) 从现有数据源进行政策相关分析的能力； (4) 成功过渡到一个新的、研究很少的卫生政策领域。