Jacobson’s approach relies on the concept of fiduciary duty, which refers to the duty of loyalty owed to the patient, to make sure the patient’s needs come first. Following this premise, doctors and lawyers could find common ground, since they both want to see the patient receive appropriate care in a reasonable length of time. Under the fiduciary care framework, Jacobson would expect managed care plans to set up impartial and understandable systems to decide whether to pay for treatment that a physician recommends. Judicial oversight would resolve conflicts between patients, physicians and health insurers, helping to inject fairness and clarity into decisions to delay or deny health care. The goal is not boosting litigation and making doctors and lawyers more adversarial than they already are, Jacobson said. Ideally, he said, health care and legal professionals would work together to establish clear expectations and accountability with consequences when they aren’t met. In short, Jacobson said, the patient must become the focus of health care again. "The way the system works now, the patient gets lost. My approach returns the patient to the center of the health care delivery system and it forces the managed care plans to defend and justify their choices," he said. "I’m not saying they can’t deny service. Not every patient should get every treatment, but they should have to justify those decisions." Jacobson received funding through The Robert Wood Johnson Foundation’s Investigator Awards in Health Policy Research Program.

Faculty profile of Peter Jacobson: http://www.sph.umich.edu/faculty/pdj.html Book details from Oxford University Press: http://www.oup-usa.org/isbn/0195152719.html For more about the U-M School of Public Health: http://www.sph.umich.edu

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