See Friedland, B., “Managed Care and the Expanding Scope of Primary Care Physicians' Duties: A Proposal to Redefine Explicitly the Standard of Care,” Journal of Law, Medicine & Ethics, 26 (1998): 100–12; and Hickson, G.B., “Development of an Early Identification and Response Model of Malpractice Prevention,” Law and Contemporary Problems, 60 (1997): 7–29.Google Scholar

See Friedland, , id.Google Scholar

See Employee Retirement Income Security Act of 1974, Pub. L. No. 93–406, 88 Stat. 829 (codified as amended at 29 U.S.C. §§ 1001–1461 (1988 & Supp. V. 1993)).Google Scholar

See Donabedian, A., The Definition of Quality and Approaches to Its Assessment (Ann Arbor: Health Administration Press, 1980); and Newacheck, P.W., “Monitoring and Evaluating Managed Care for Children with Chronic Illnesses and Disabilities,” Pediatrics, 98 (1996): 952–58. Examination of quality in medicine may include studies of patient satisfaction, the process of care, and outcomes. All are difficult to perform and subject to a number of well-documented biases, which make interpretation difficult. Such difficulties are compounded by the tremendous variations on the managed care theme.Google Scholar

See Fuchs, V.R. Kramer, M.J., Determinants of Expenditures for Physicians' Services in the United States 1948–1968 (Washington, D.C.: National Center for Health Services Research and Development, 1972); Luft, H.S., Health Maintenance Organizations: Dimensions of Performance (New York: John Wiley, 1981); Hickson, G.B., “Physician Reimbursement by Salary or Fee-for-Service: Effect on Physician Practice Behavior in a Randomized Prospective Study,” Pediatrics, 80 (1987): 344; and Wennberg, J. Gittelsohn, A., “Variations in Medical Care Among Small Areas,” Scientific American, 246, no. 4 (1982): 120–34.Google Scholar

See Newacheck, , supra note 4; Ray, W.A., “Perinatal Outcomes Following Implementation of TennCare,” JAMA, 279 (1998): 314–16; and Retchin, S.M., “Outcomes of Stroke Patients in Medicare Fee for Service and Managed Care,” JAMA, 278 (1997): 119–24. The results of studies examining quality in managed care are mixed, in part because of difficulties in assessing quality.Google Scholar

See Friedland, , supra note 1, at 101.Google Scholar

See Lavelle-Jones, C., “Factors Affecting Quality of Informed Consent,” British Medical Journal, 306 (1993): 885–90; and Stanley, B., “The Elderly Patient and Informed Consent: Empirical Findings,” JAMA, 252 (1984): 1302–06.Google Scholar

See Wickline v. State of California, 239 Cal. Rptr. 810 (Ct. App. 1986); and Hickson, G.B., “Pediatric Practice and Liability Risk in a Managed Care Environment,” Pediatric Annals, 26 (1997): 179–85.CrossRefGoogle Scholar

See Hickson, , id. Physicians may need professional assistance with contract negotiations.Google Scholar

See Sage, W.M. Hastings, K.E. Berenson, R.A., “Enterprise Liability for Medical Malpractice and Health Care Quality Improvement,” American Journal of Law & Medicine, XX (1994): 1–28. My recommendation differs in that physicians would not be immune from suits while employed or under contract with a health plan. Physicians must remain at risk because their nontechnical behaviors are responsible for prompting the majority of suits. See Hickson, G.B., “Factors that Prompted Families to File Medical Malpractice Claims Following Perinatal Injuries,” JAMA, 267 (1992): 1359–63; and Hickson, G.B., “Obstetricians' Prior Malpractice Experience and Patients' Satisfaction with Care,” JAMA, 272 (1994): 1583–87.Google Scholar

See Pichert, J.W., “Understanding the Etiology of Serious Medical Events Involving Children: Implications for Pediatricians and Their Risk Managers,” Pediatric Annals, 26 (1997): 160–72. Errors in medicine are most often related to the system of care, not to individual physicians making specific decisions.Google Scholar