October 1998 Bulletin

Patient protections vary widely in U.S.

South Dakota is the only state in the United States that has not adopted any patient protections, but provisions to protect consumers from managed care-related problems vary widely in the remaining 49 states, according to a study conducted by the Families USA Foundation.

The study looked at several areas of consumer protections-emergency room services, access to providers, continuity of care, drug formularies, appeals, consumer assistance programs, patient physician relationships, clinical trials and liability. The study broke down the area of access to providers even further, checking out which states had passed laws requiring plans to:

In looking at patient physician relationships, the study checked which states had laws that prohibit plans from preventing the disclosure of treatment options and/or prohibit plans from offering incentives to physicians for denying or reducing care.

As of June 1998, no state had enacted all 13 of the provisions included in the study and only Vermont had enacted 10 or more. Sixteen states had enacted between five and nine of the protections and 33 had enacted at least one but fewer than five.

The study also found that of those consumers provided health insurance by their employer, 83 percent are preempted under the federal Employee Retirement Income Security Act (ERISA) from seeking state-prescribed remedies for wrongful denial of care.


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