Noting a sixfold increase in managed care enrollment and responding to a lack of consumer confidence in managed care organizations, New Jersey drafted new HMO regulations, which were then codified in a statute. The New Jersey Department of Health and Senior Services convened an advisory committee to develop a consumers' bill of rights, incorporated into the statute, that ensures consumer protections, preserves the patient-provider relationship, and promotes a competitive marketplace. A number of states are attempting to equate increased options of choice with better quality of care. Proponents of consumer rights-type legislation argue that patients are finding it increasingly difficult to assert their rights in the managed care arena, and that such protections are necessary to ensure access and quality. Opponents respond that the legislation imposes too many rules and represents government interference with managed care organizations' autonomy.
Opponents further believe that increased choice leads only to increased administrative costs.
As expected, the managed care industry is fully engaged in this debate on the regulation of health plans. Interestingly, the industry appears to be divided over whether a mandated or voluntary approach to regulation is in its best interest. However, AAHP opposes further mandatory regulation. Because health plans provide access to health care services through networks of participating providers, state agencies have begun to measure and regulate the adequacy of such networks and choice of providers. Direct access initiatives provide individuals enrolled in managed care plans with direct access to providers other than traditional primary care gatekeepers.