Expert Witness Topics/Issues

Expert Witness Topics/Issues

System Design and Construction

·  Inter-relationships and/or Conflicts among Law, Economics, Ethics and Medicine, as affecting and effecting delivery of health care

·  Problems with delivery (i.e., flow) of patient care within a provider (hospital, doctor, lab, et al.)

·  Insurance contract issues which permit/prevent delivery of care

·  Standards of Care – medical, legal, practical --- from systems design

·  Payor-Provider Issues à consequences to patients

·  Access to and/or Availability of care

·  Risk Management

·  Contracts, re: outcomes, delivery, et al.

Insurance-Related Issues

·  Claims (including denial of care from claims processing problems)

·  Improper denial of coverage

·  Improper processing of claims

·  Breaches of contract re: claims

·  Pharmaceutical Issues

·  Coverage --- consequences to patients and delivery of care

·  Universal vs Limited Coverage

·  Cost

·  Differences re: HMOs, MCOs, Medicaid/Medicare

·  Pharmaceutical Benefits Managers

·  Formularies

·  Costs

·  ‘Hidden Agendas’ (see also risk management, below)

·  Contracts between/among Payors, PBMs, Providers

·  HMOs, MCOs, PPOs, et al.

·  Structural Limitations of Delivered Care, e.g.,

·  Rationing

·  Artificial and Contract-Related Mechanisms

·  Payment Schemes

·  Standards of Care – national, medical, legal, practical, et al.

Risk Management Issues

·  Cost-shifting vs

·  Liability

·  Financial Risk-Shifting

·  Medical Risk Shifting

·  Quality of Care vs

·  Availability and Access

·  Quantity of Care

·  Cost and Delivery of Care

·  Ethics – Institutional, Economic, System Design…

·  End-of-Life Decision-Making

·  Beginning-of-Life Decision-Making

·  Substituted Judgment Issues

·  Advance Directives and Powers of Attorney

·  Intra-Institutional (structural, policy, operational)

·  Morbidity and Mortality (e.g., Avoidable)

·  Cost

·  Resource Consumption

·  Liability

·  Billing/Collections

·  Diagnosis and Treatment

·  Et al.

·  Public Policy and Governmental Influences re: patient care

·  Access

·  Availability

·  Legislation and Regulation

·  Cross-Border (especially vis-à-vis Canada)

·  Resource Allocation: Organic, Inorganic, and $$ resources

·  Scarce Resources

·  Non-Recyclable Resources

·  Recyclable and Prohibitive/Prohibited Recycling

·  Economic and Physical Constraints Altering Delivery

·  Cross-Border Issues of Delivery

·  Human resources

·  Foreign practices

·  Contractual

·  Foreign patient populations