Question 1
No, under the current legal framework on healthcare, physicians practicing in a group practice in primary care setting do not have the right to choose what types of patients they can treat in terms of health insurance and disease conditions. According to Sekhri (2000), the managed healthcare system under the Act only gives patients the option of choosing the type of insurance, whether private or public payer but not physicians. Fodeman (n.d) argues that, the new law on health, the Affordable Care Act is likely to interfere with the doctors’ autonomy and flexibility in making decisions on which insurance plans are to be taken by patients based on their medical conditions. The author argues that the Act places unreasonable bureaucratic procedures and red tape on physicians (Fodeman, n.d). Moreover, this could automatically discriminate against those patients with certain medical conditions not covered by the Act or with other reimbursement sources as it will tie the unnecessarily to state-mandated healthcare which may not satisfy their medical preferences and who may need to consult specialist physicians (Sekhri, 2000).
Question 2
The tort reform which would see medical practitioners barred from engaging in the practice of defensive medicine was excluded from the Affordable Care Act when it came into force in 2010 majorly because political opinion was divided on the matter between the Democratic and Republicans in the Senate (Youn, 2012). The stakeholders who benefited much from the omission of tort reform from the Obama Care Act are mainly the doctors who would be weighed down by litigation had a provision been inserted in the Act requiring them to take liability insurance. Injured patients also benefited as the malpractice reform provision would increase the costs of healthcare for them.
Question3
ERISA means the Employee Retirement Income Security Act enacted by the US federal government in 1974. It provides employer-based healthcare plans for employees as noted by Hellinger andYoung (2005). This is an important consideration whenever a suit is brought against a managed care organization as it contains a presumption in favor of the patient that the healthcare organization was at fault thus reducing the burden of proof on the plaintiff. It preempts vicarious liability on the part of the healthcare organization for any medical negligence by its employees (Rothstein, 2010). This is an important consideration for managed care organizations because they have to ensure that their employees observe due care and diligence at all times lest they be held liable for the negligent acts of their employee nurses and doctors.. According to Steiner, ERISA is important when MCOs are contracting with employers (Hellinger & Young, 2005).
References
Fodeman, J. (n.d). The new health law: Bad for patients, awful for patients. Retreived February 4, 2016, from http://www.theihcc.com/en/communities/policy_legislation/the-new-health-law-bad-for-doctors-awful-for-patie_gn17y01k.html
Hellinger, F. J., & Young, G. J. (2005). Health plan liability and ERISA: The expanding scope of state legislation. American Journal of Public Health, 95(2), 217-223.Retrieved February 4, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449155/pdf/0950217.pdf
Rothstein, M. A. (2010). Health care and medical malpractice claims. Journal of Law & Medical Ethics, 38(4), 871-874. Retrieved February 4, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077940/pdf/nihms264895.pdf
Sekhri, N. K. (2000). Managed care: The US experience. B ulletin of the World Health Oganization Journal, 78(6), 830-843.
Steiner, J. E. (2013). Problems in healthcare law. New York: Johns & Bartlett Publishers.
Youn, A. (2012, October 5). Health care act's glaring omission: liability reform. CNN. Retrieved February 4, 2016, from http://edition.cnn.com/2012/10/05/health/youn-liability-reform/
