Whodunit?: Causal Responsibility of Utilization Review for Physicians' Decisions, Patients' Outcomes
Morreim, E. Haavi
Law, Medicine and Health Care. 1992 Spring-Summer; 20(1-2): 40-56.
...This article inquires whether it is ever appropriate to ascribe causality to UR's [utilization review] influence on physicians' decisions and on patients' outcomes. On the one hand, it seems odd to suppose that the physician, a free agent, can be caused to make an ill-advised medical decision, simply because UR has stated that the insurer does not owe payment. On the other hand, it seems naive to suppose that physicians can continue to order costly medical interventions regardless of payment. After surveying such practical and philosophical considerations in Section II, I will examine traditional legal theories of causation in Section III. Such analyses enable us to recognize, for instance, that UR can directly cause delays and other potentially harmful changes in care. Indirectly, UR can harm patients by improperly influencing physicians' decisions, as by coercion or deception. I will argue, however, that if we are fully to understand why and when UR should be held causally responsible, we must turn to a nontraditional account of causality....
Coercion; Deception; Decision Making; Economics; Harm; Health; Health Care; Health Insurance; Hospitals; Incentives; Injuries; Insurance; Legal Obligations; Liability; Patient Admission; Patient Advocacy; Patients; Peer Review; Physicians; Remuneration; Resource Allocation; Review; Standards; Torts; Withholding Treatment;
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