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Improving Dispute Resolution in Health Care

改善医疗保健领域的争议解决

基本信息

批准号：
6616186
负责人：
DAVID M STUDDERT
金额：
$ 9.07万
依托单位：
HARVARD SCHOOL OF PUBLIC HEALTH
依托单位国家：
美国
项目类别：
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/6616186
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

项目摘要

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律、卫生政策和医学伦理产生了兴趣。到目前为止，研究的重点是医疗事故。然而，最近，我的兴趣被吸引到了医疗差错和医疗纠纷的法律问题上。本提案中概述的议程与后者有关。它的前提是，提高对医疗保健纠纷的认识--特别是关于纠纷产生的原因、如何解决纠纷以及争议各方身份的信息--将有助于指导政策和实践取得三个积极成果：(1)改善医疗质量；(2)为管理医疗参与者提供更大的程序正义和公平性；以及(3)降低成本。在接下来的四年里，有两个项目将占据我大部分时间。第一项研究始于1999年10月，是关于管理型医疗机构的保险决策的研究。它的目标是描述和分析管理保健人群中拒绝承保的情况，特别关注弱势投保人(例如穷人、少数族裔、那些缺乏医生支持其索赔的人)在上诉承保决定时的情况。该项目的数据来自加州的两个大型医疗计划和两个医疗组织。第二项研究有类似的培训目标，但集中在对覆盖呼吁的外部审查，特别是在管理性医疗中的联邦医疗保险受益人中。我们目前正在与美国最大的外部审查机构卫生纠纷解决中心的合作者一起制定一项提案。除了提供与上述研究有关的一系列激动人心的规范性和描述性研究问题的机会外，拟议的奖励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)赠款撰写经验；(3)从现有数据来源进行与政策相关的分析的能力；以及(4)成功过渡到一个新的、很少被研究的卫生政策领域。