Chapter 8.E.1: Open-Ended Reimbursement

To insert after Ch. 8.E.1 (p. 830):

On the irrationality of medical prices (note 1), Steven Brill, Bitter Pill: Why Medical Bills Are Killing Us, Time, Feb. 20, 2013; Erin C. Fuse Brown, Irrational Hospital Pricing, 14 Hous. J. Health L. & Pol’y 11 (2014); George A. Nation III, Healthcare and the Balance-Billing Problem, 61 Vill. L. Rev. 153 (2016). 

For discussions of whether exorbitant contracts should be enforced (note 1), see Hall & Schneider, supra, 106 Mich. L. Rev. 643; Wendy Epstein, Price Transparency and Incomplete Contracts in Health Care, 67 Emory L. J. (2017); James McGrath, Overcharging the Uninsured in Hospitals: Shifting a Greater Share of Uncompensated Medical Care Costs to the Federal Government, 26 Quinnipiac L. Rev. 173 (2007); George A. Nation III, Obscene Contracts: The Doctrine of Unconscionability and Hospital Billing of the Uninsured, 94 Ky L. J. 101, 121-123 (2006). For general analysis, see Haavi Morreim, High-Deductible Health Plans: New Twists on Old Challenges from Tort and Contract, 59 Vand. L. Rev. 1207 (2006); Comment, 78 Temp. L. Rev. 493 (2005); Government Accountability Office, Health Care Price Transparency (2011); Kelly Kyanko & Susan Busch, The Out-of-Network Benefit: Problems and Policy Solutions, 49 Inquiry 352 (2012).

For discussions of market power in the health care industry (note 3), see Lucia Savage, Martin Gaynor, & Julia Adler-Milstein, Digital Health Data and Information Sharing: A New Frontier for Health Care Competition?, 82 Antitrust L.J. 593 (2019); Martin Gaynor et al., Making Health Care Markets Work, 317 JAMA 1313 (2017); Thomas G. McGuire, Physician Agency, in Anthony J. Culyer & Joseph P. Newhouse, Handbook of Health Economics 462, 482, 527 (2000); Martin Gaynor, Issues in the Industrial Organization of the Market for Physician Services, 3 J. Econ. Manag. Strat. 211 (1994); Reuben Kessel, Price Discrimination in Medicine, 1 J. L. & Econ. 20 (1958).

For more on medical debt and bankruptcy (note 4), see Frank Griffin, Fighting Overcharged Bills from Predatory Hospitals, 51 Ariz. St. L.J. 1003 (2019); Melissa B. Jacoby et al., Rethinking the Debates over Health Care Financing: Evidence from the Bankruptcy Courts, 76 N.Y.U. L. Rev. 375 (2001); Melissa B. Jacoby & Elizabeth Warren, Beyond Hospital Misbehavior: An Alternative Account of Medical-Related Financial Distress, 100 Nw. U. L. Rev. 535 (2006); Melissa Jacoby & Mirya Holman, Managing Medical Bills on the Brink of Bankruptcy, 10 Yale J. Health Pol’y L. & Ethics 239 (2010); Symposium, 51 St. Louis U. L. J. 293 (2007); Daniel A. Austin, Medical Debt As a Cause of Consumer Bankruptcy, 67 Me. L. Rev. 1 (2015).

For discussions of surprise medical bills (note 5), see Mark A. Hall et al., Solving Surprise Medical Bills (Brookings, 2016); Daryl M. Berke, Drive-by-Doctoring: Contractual Issues and Regulatory Solutions to Increase Patient Protection from Surprise Medical Bills, 42 Am. J. L. & Med. 170 (2016); Erin C. Fuse Brown, Consumer Financial Protection in Health Care, 95 Wash. U. L. Rev. __ (2017).

For discussions of the extent of medical fraud (note 7), see Joan Krause, Following the Money in Health Care Fraud, 36 Am. J. L. & Med. 343 (2010); Michael K. Sparrow, License to Steal: Why Fraud Plagues America’s Health Care System (1999); Symposium, 51 U. Ala. L. Rev. 1 (1999); Symposium, 3 Quinnipiac Health L. J. 1 (2000); Symposium, 43 St. Louis L. Rev. 1 (1999). For more on routine, low-level fraud, see Victor G. Freeman et al., Lying for Patients: Physician Deception of Third-Party Payers, 159 Arch. Intern. Med. 2263 (1999); Matthew K. Wynia et al., Physician Manipulation of Reimbursement Rules for Patients: Between a Rock and a Hard Place, 283 JAMA 1858 (2000).