In the first half of 1996, some thirty-three states enacted laws to provide consumers of managed care health services with stronger protections. These laws involved such issues as access to specialists, “gag rules,” emergency care, appeal rights on wrongful denial of care, and maternity length-of-stay requirements. And a bipartisan bill to bar health maintenance organizations from imposing “gag rules” on physicians' ability to share full treatment information with their patients nearly passed in the closing days of the 104th Congress. These and other “anti-managed care” laws are but one mechanism—albeit a controversial one—available to improve accountability for quality of care within the managed care sphere. Here, author Alice Gosfield neatly lays out the range of techniques now used for holding managed care accountable.

Gosfield practices law in Philadelphia through Alice G. Gosfield and Associates, P.C. She is also “of counsel” with Blackwood and Langworthy, L.C., of Kansas City, Missouri. Since 1973 she has focused her practice on health law and health care regulation, with a special emphasis on managed care, fraud and abuse, and utilization and quality issues, among others. Past president of the National Health Lawyers Association, she also has served on four committees of the National Academy of Sciences Institute of Medicine studying utilization management and clinical practice guidelines. Since 1992 Gosfield has served on the board of the National Committee for Quality Assurance. She received her law degree from New York University Law School and her undergraduate degree from Barnard College. Her most recent book, published in late December 1996, is Guide to Key Legal Issues in Managed Care Quality (profiled in UpDate in this volume).

ABSTRACT: The debate over accountability for managed care quality is occurring everywhere, from Congress and state legislatures to courtrooms and boardrooms. This paper reviews a variety of today's techniques for holding managed care answerable for quality, ranging from those grounded in the law to more market-based approaches, including accreditation and commerce in data about plan performance. Today, there is some dissonance between purchasers' rhetoric about quality and their actual buying behavior. Eventually the discussion of accountability for quality may really be joined when the baby boomers become the consumers of this system and not just its financiers.