Rationality and Consent in the New Medical Marketplace

Award Year:
M. Gregg Bloche
Ethical Dilemmas and Resource Allocation, Healthcare Markets
Conflicts have erupted among patients, providers, and payers as a result of the market-driven transformation of the American health care system. These are playing out in coverage decisions by payers, selective contracting between plans and providers, tort liability cases, disclosure and consent issues, and the protection of health information privacy. Dr. Bloche develops an analytic framework to explore the moral, social, and institutional tensions underlying legal conflicts in health care delivery. He studies the problematic character and conflicting interpretations of rationality and consent as bases for ordering relations between patients, providers and payers. Building upon the paradigms of bounded rationality and relational contracting, he draws from the growing legal, economics and psychology literature on incomplete rationality and informal dispute processing mechanisms. His findings propose an array of approaches to the resolution of disputes arising from the growth of managed care.