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Leveraging Quality in Managed Care: Moving Advocates Back into the Box

Posted: 15 Aug 2002  

John D. Blum

Loyola University of Chicago Law School


This article is written as a companion piece to the article, "Public Interest Lawyers and New Governance: Avocating for Health Care" by Professor Louise Trubek. The article first examines the core theme of health care quality, and reviews the key strategies in adddressing quality issues, namely structure, process, outcome and consumerism. The piece juxtaposes the quality efforts with the current realities of patient safety and medical errors, and calls into question the viability of past quality initiatives. It is pointed that while quality efforts may have resulted in certain successes, there is a clear need for renewed advocacy in this area, including local alliances recommended by the Institute of Medicine and the model of community advocacy, suggested in the piece by Professor Trubek.

The article explores, in a critical fashion, the Trubek analysis of health care governance, which is characterized by movements, "outward", "downward" and "outside the regulatory box". The author notes that while the movements noted by Trubek are real, they maybe not be so novel or deliberate as is suggested. For example, this article views health care federalism, the movement downward, as a reflection of a void in federal policy, a process of deliberate delegation, and a means by which state governors have tapped into national funding.

The piece concludes with a recognition that advocay efforts will have to be increased, if areas such as quality, are to remain priorities in the post September 11th world. The article supports the Trubek model, but calls for advocay efforts to continue at federal levels, and at points of interface between federal and state government. While certain decisions in health care policy have drifted downward, this piece argues that health care policy at the local level is still in many ways a creature of policies forged at higher levels of government, a lesson advocates should not ignore.

Suggested Citation

Blum, John D., Leveraging Quality in Managed Care: Moving Advocates Back into the Box. Wisconsin Law Review, Vol. 2002, No. 2. Available at SSRN:

John D. Blum (Contact Author)

Loyola University of Chicago Law School ( email )

25 E. Pearson
Chicago, IL 60611
United States

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