Enterprise Liability and the Emerging Managed Health Care System

“Enterprise medical liability” is a term used to describe a system in which health care organizations bear responsibility for medical malpractice in addition to or instead of individual health professionals. Enterprise liability is in many senses a natural outgrowth of the increasing dependence of medical practice on institutional resources and expertise. Proposals for enterprise liability surfaced briefly from the academic literature into the political spotlight during the 1993-94 health care reform debate. At that time, objections to the concept as a basis for medical malpractice liability, even in a restructured health care system, were nearly universal. Just five years later, many of the groups vehemently opposing the Clinton malpractice reform have become vigorous supporters of managed care liability. Moreover, courts and legislatures are holding managed care organizations accountable for malpractice in ways superficially compatible with the Clinton proposal. In the process, however, enterprise liability has been transformed from a theory without a movement to a movement without a theory. This article explores why this happened, whether it is likely to be a transitory phase or a sustained trend, and what it portends for the public policy objectives of medical tort law. Part II of this article describes the theoretical justifications for imposing liability for medical malpractice on managed care organizations, emphasizing proposals that were made in connection with the national health care reform debate. Part III explains why enterprise liability failed to attract support in 1993-94. Part IV discusses the very different attitudes that prevail in 1998, and details the legal manifestations of the current movement to expand malpractice liability in managed care. Parts V and VI of the article analyze the relationship among theoretical constructs of enterprise liability, the reality of today’s managed care marketplace, and the legal response managed care has provoked. Specifically, Part V outlines several respects in which the market and the legal system have moved away from characteristics that previously made enterprise liability desirable, and Part VI identifies potentially significant trends that could lead to a rapprochement between our health care system and the public policy justifications for extending malpractice liability to managed care organizations. Finally, Part VII suggests that federal legislation is necessary for malpractice liability to serve socially constructive purposes in managed care, and identifies a set of principles that should guide future legislative action

Industry 4.0 perspectives in the health sector in Brazil

Health 4.0 can be understood as the set of procedures that seek to improve the efficiency and speed of health professionals with possible guidelines for combining patient data in hospitals. However, systematizing and qualitatively describing the contributions of industry 4.0 in the context of the Brazilian health sector is a complex task. The aim of this paper is to present an analysis of industry 4.0 related to the health sector and its respective characteristics in Brazil. In addition, it discusses the prospects for greater use of technology in health care. In methodological terms, an exploratory field research was conducted with a non-random and intentional sample of professionals working in the technological context of Brazilian health. The research is classified as descriptive and qualitative, exploratory. The results contribute to narrow the information gap about industry 4.0 in the Brazilian health sector. The study allowed to develop a concept map of health 4.0 regarding the professional profile, considering the adoption of technologies that may favor the sector

State Implementation of National Health Reform: Harnessing Federal Resources to Meet State Policy Goals

Discusses state options for maximizing coverage and access to care; reforming the health insurance market; holding insurers accountable for high-quality, affordable coverage; restructuring healthcare delivery and financing; and cutting budget deficits

Copayment and recommended strategies to mitigate its impacts on access to emergency medical services under universal health coverage: a case study from Thailand

Abstract Background Although bodies of evidence on copayment effects on access to care and quality of care in general have not been conclusive, allowing copayment in the case of emergency medical conditions might pose a high risk of delayed treatment leading to avoidable disability or death. Methods Using mixed-methods approach to draw evidence from multiple sources (over 40,000 records of administrative dataset of Thai emergency medical services, in-depth interviews, telephone survey of users and documentary review), we are were able to shed light on the existence of copayment and its related factors in the Thai healthcare system despite the presence of universal health coverage since 2001. Results The copayment poses a barrier of access to emergency care delivered by private hospitals despite the policy proclaiming free access and payment. The copayment differentially affects beneficiaries of the major 3 public-health insurance schemes hence inducing inequity of access. Conclusions We have identified 6 drivers of the copayment i.e., 1) perceived under payment, 2) unclear operational definitions of emergency conditions or 3) lack of criteria to justify inter-hospital transfer after the first 72 h of admission, 4) limited understanding by the service users of the policy-directed benefits, 5) weak regulatory mechanism as indicated by lack of information systems to trace private provider’s practices, and 6) ineffective arrangements for inter-hospital transfer. With demand-side perspectives, we addressed the reasons for bypassing gatekeepers or assigned local hospitals. These are the perception of inferior quality of care and age-related tendency to use emergency department, which indicate a deficit in the current healthcare systems under universal health coverage. Finally, we have discussed strategies to address these potential drivers of copayment and needs for further studies

The ethics of uncertainty for data subjects

Modern health data practices come with many practical uncertainties. In this paper, I argue that data subjects’ trust in the institutions and organizations that control their data, and their ability to know their own moral obligations in relation to their data, are undermined by significant uncertainties regarding the what, how, and who of mass data collection and analysis. I conclude by considering how proposals for managing situations of high uncertainty might be applied to this problem. These emphasize increasing organizational flexibility, knowledge, and capacity, and reducing hazard

An intelligent framework using disruptive technologies for COVID-19 analysis

This paper describes a framework using disruptive technologies for COVID-19 analysis. Disruptive technologies include high-tech and emerging technologies such as AI, industry 4.0, IoT, Internet of Medical Things (IoMT), big data, virtual reality (VR), Drone technology, and Autonomous Robots, 5 G, and blockchain to offer digital transformation, research and development and service delivery. Disruptive technologies are essential for Industry 4.0 development, which can be applied to many disciplines. In this paper, we present a framework that uses disruptive technologies for COVID-19 analysis. The proposed framework restricts the spread of COVID-19 outbreaks, ensures the safety of the healthcare teams and maintains patients' physical and psychological healthcare conditions. The framework is designed to deal with the severe shortage of PPE for the medical team, reduce the massive pressure on hospitals, and track recovered patients to treat COVID-19 patients with plasma. The study provides oversight for governments on how to adopt technologies to reduce the impact of unprecedented outbreaks for COVID-19. Our work illustrates an empirical case study on the analysis of real COVID-19 patients and shows the importance of the proposed intelligent framework to limit the current outbreaks for COVID-19. The aim is to help the healthcare team make rapid decisions to treat COVID-19 patients in hospitals, home quarantine, or identifying and treating patients with typical cold or flu.</p