An innovative design crafted by Peter D. Jacobson, associate professor at the University of Michigan’s School of Public Health, would use the courts to inject greater clarity and fairness into health plans’ decisions to delay or deny care. The judicial system plays a significant role in deciding whether and how millions of Americans receive and experience health care. Legislators make laws and managed care administrators formulate policy, but the courts wield a different type of power by converting sometimes fuzzy policies and regulations into clear legal guideposts.

Jacobson’s fresh approach to reform weaves the judicial system and the concept of fiduciary duty into a promising model for working out differences among payers, providers, and patients. He will soon publish his blueprint for reform in his new book, Strangers in the Night: Law and Medicine in the Managed Care Era, with support from a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.

Jacobson’s prescription for health policy reform would:

• Rely on health care fiduciaries with the legal duty to follow carefully established guidelines and objectively balance the needs of individual patients with the need to preserve scarce resources for their fellow health plan members; and
• Use the courts to ensure that fiduciaries’ decisions meet strict standards for fairness.