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State Legislatures Move To Ban
'Gag Rules' Imposed on Physicians

Use of so-called "gag rules" by managed care plans is under attack in many states. Bills to ban these rules–which prevent physicians from discussing treatment options, payment policies and other plan provisions with patients–have been introduced in at least 24 states this year, says Anne Markus of George Washington University's Intergovernmental Health Policy Project. Physician groups seek to ban these rules because, they argue, gag orders interfere with the doctor-patient relationship, stifling the ability of physicians to:

Florida Measure Encouraging Suits Vs. HMOs Vetoed

Florida Gov. Lawton Chiles has vetoed a bill that would have allowed patients to sue their HMOs more easily in cases where medical care is denied. Florida would have been the first state to allow enrollees to sue for compensatory and punitive damages as well as legal fees when an HMO denies payment for a treatment ordered by any doctor.

The measure, HB 1853, was supported by trial lawyers, but business groups opposed it. "The business community, which pays most of the costs for privately funded health insurance, has never agreed to this bill," said Jon Shebel, president and CEO of the Associated Industries of Florida.

The governor, a Democrat, said the bill "would encourage a return to the era of 'defensive medicine' that helped to spur sharp increases in health care costs during the 1980s."

He speculated that doctors would have an incentive to authorize services and would do so "whenever there was a doubt about the need or efficacy" of a treatment.

"The tendency in most cases would be to require the HMO to pay for the service, regardless of cost," resulting in "erosion of the ability to perform utilization management."

–Joan Szabo


MANAGED CARE July 1996. ©1996 Stezzi Communications