Author Affiliations: School of Public Health, University of Michigan, Ann Arbor (Mr Jacobson) and Ropes and Gray, Boston, Mass (Mr Pomfret).
Health Law and Ethics Section Editors: Lawrence
O. Gostin, JD, the Georgetown/Johns Hopkins University Program in Law and
Public Health, Washington, DC, and Baltimore, Md; Helene M. Cole, MD, Contributing
The Employee Retirement Income Security Act (ERISA), enacted in 1974
to regulate pension and health benefit plans, is a complex statute that dominates
the managed care environment. Physicians must understand ERISA's role in the
relationship between themselves and managed care organizations (MCOs), including
how it can influence clinical decision making and physician autonomy.
This article describes ERISA's central provisions and how ERISA influences health
care delivery in MCOs. We analyze ERISA litigation trends in 4 areas: professional
liability, utilization management, state legislative initiatives, and compensation
arrangements. This analysis demonstrates how courts have interpreted ERISA
to limit physician autonomy and subordinate clinical decision making to MCOs'
cost containment decisions. Physicians should support efforts to amend ERISA,
thus allowing greater state regulatory oversight of MCOs and permitting courts
to hold MCOs accountable for their role in medical decision making.
Jacobson PD, Pomfret SD. ERISA Litigation and Physician Autonomy. JAMA. 2000;283(7):921-926. doi:10.1001/jama.283.7.921