Improving Dispute Resolution in Health Care

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差错和医疗纠纷中的法律的问题。 本提案中概述的议程涉及后者。 它是基于一个总体假设，即关于医疗保健纠纷的知识进步，特别是关于纠纷产生原因、解决方式和纠纷当事人身份的信息，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）提高管理式护理注册者的程序正义和公平性;（3）降低成本。在接下来的四年里，两个项目将占据我的大部分时间。 第一项研究是对管理式医疗机构的覆盖决策的研究，始于1999年10月。 它的目标是描述和分析管理的护理人群中的保险覆盖的拒绝，特别关注如何脆弱的参保者（例如穷人，少数民族，那些缺乏医生支持他们的索赔）票价在上诉覆盖的决定。 该项目的数据来自加州的两个大型健康计划和两个医疗团体。 第二项研究有类似的培训目标，但集中在外部审查的覆盖上诉，特别是在医疗保险受益人在管理式医疗。 与卫生争议解决中心的合作者，该国最大的外部审查员，我们目前正在制定一项提案。以及提供机会，追求一系列令人兴奋的规范性和描述性的研究问题与上述研究，拟议的奖项将使我的时间和灵活性，以发展我的职业生涯在几个关键领域：（1）定量和定性的技能相关的实证研究在卫生法;（2）赠款写作经验;（3）从现有的数据来源进行政策相关的分析能力;（4）在未来的研究中，我将继续努力。以及（4）成功过渡到一个新的，很少研究的卫生政策领域。

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.