{"title":"Unmanaged care: towards moral fairness in health care coverage.","authors":"Sharona Hoffman","doi":"","DOIUrl":null,"url":null,"abstract":"<p><p>Health insurers are generally guided by the principle of \"actuarial fairness,\" according to which they distinguish among various risks on the basis of cost-related factors. Thus, insurers often limit or deny coverage for vision care, hearing aids, mental health care, and even AIDS treatment based on actuarial justifications. Furthermore, approximately forty-two million Americans have no health insurance at all, because most of these individuals cannot afford the cost of insurance. This Article argues that Americans have come to demand more than actuarial fairness from health insurers and are increasingly concerned by what I call \"moral fairness.\" This is evidenced by the hundreds of laws that have been passed to constrain insurers' discretion with respect to particular coverage decisions. Legislative mandates are frequent, but seemingly haphazard, following no systematic methodology. This Article suggests an analytical framework that can be utilized to determine which interventions are appropriate and evaluates a variety of means by which moral fairness could be promoted in the arena of health care coverage.</p>","PeriodicalId":46974,"journal":{"name":"Indiana Law Journal","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indiana Law Journal","FirstCategoryId":"90","ListUrlMain":"","RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"LAW","Score":null,"Total":0}
引用次数: 0
Abstract
Health insurers are generally guided by the principle of "actuarial fairness," according to which they distinguish among various risks on the basis of cost-related factors. Thus, insurers often limit or deny coverage for vision care, hearing aids, mental health care, and even AIDS treatment based on actuarial justifications. Furthermore, approximately forty-two million Americans have no health insurance at all, because most of these individuals cannot afford the cost of insurance. This Article argues that Americans have come to demand more than actuarial fairness from health insurers and are increasingly concerned by what I call "moral fairness." This is evidenced by the hundreds of laws that have been passed to constrain insurers' discretion with respect to particular coverage decisions. Legislative mandates are frequent, but seemingly haphazard, following no systematic methodology. This Article suggests an analytical framework that can be utilized to determine which interventions are appropriate and evaluates a variety of means by which moral fairness could be promoted in the arena of health care coverage.
期刊介绍:
Founded in 1925, the Indiana Law Journal is a general-interest academic legal journal. The Indiana Law Journal is published quarterly by students of the Indiana University Maurer School of Law — Bloomington. The opportunity to become a member of the Journal is available to all students at the end of their first-year. Members are selected in one of two ways. First, students in the top of their class academically are automatically invited to become members. Second, a blind-graded writing competition is held to fill the remaining slots. This competition tests students" Bluebook skills and legal writing ability. Overall, approximately thirty-five offers are extended each year. Candidates who accept their offers make a two-year commitment to the Journal.