A consumer-choice health plan for the 1990s: universal health insurance in a system designed to promote quality and economy

Article Abstract:

The health care industry in the U.S. absorbs nearly 11.5 percent of the gross national product, more than any other country, yet approximately 35 million Americans have no protection against the potentially enormous costs of medical care. Over the past decade, the number of individuals who are not covered by some form of insurance has risen. The system itself is inflationary. It is still dominated by fee-for-service payments of doctors and hospitals with open limits. The system provides no incentive for increased efficiency and for providing alternate treatments which produce similar outcomes, but which cost less. Health maintenance organizations (HMOs) and preferred-provider (PPIs) insurance plans currently provide benefits for 60 million Americans. These alternatives can produce a more cost-conscious group of consumers, but their impact is partially reduced because workers currently do not have to pick up the added expense when they select a more costly medical care provider. To protect those who are not currently covered by medical care insurance, the authors propose that all Americans who are not covered by Medicare or Medicaid be allowed to purchase affordable public or corporate-sponsored medical insurance. A proposed strategy is to allow the sponsor to act as agent for the individuals and for the sponsor to negotiate with competing health plans as a means of securing cost-effective coverage. This process rewards providers who deliver high-quality health care at a reasonable price.

Social aspects, Health insurance

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The marketplace in health care reform: the demographic limitations of managed competition

Article Abstract:

Less than half of the US population lives in areas that could support a type of health care reform called managed competition. The theory behind managed competition, a proposal supported by President Clinton and members of Congress, is that individual provider groups such as health maintenance organizations (HMO) compete for health consumers. A study on the minimal population needed to sustain managed competition based estimates on the existing physician-enrollee ratio of successful HMOs and on the assumption that at least three health plans are needed for competition. A community of at least 1.2 million people could support three fully independent HMOs. A community of 360,000 could support three HMOs, but there would have to be some sharing of facilities and specialized services. A community of 180,000 could support three plans but would have to share cardiology and urology services. For the 37% of the population that does not live in areas with health markets greater than 360,000, alternative approaches to health care reform will be needed.

Demographic aspects, Managed care plans (Medical care), Health care reform

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A consumer-choice health plan for the 1990s: universal health insurance in a system designed to promote quality and economy

Article Abstract:

The necessary characteristics of an acceptable unviersal health coverage plan are outlined and examined. A plan is proposed that would allow consumers a choice among health plans already available in the private sector. It would encourage competition among the various plans for participation of both enrollees and physician providers. The institution of such a plan should be effected in increments, avoid large scale income redistribution and not be inflationary. The various providers would be encouraged to become more efficient, attract committed physicians, and improve quality and cost-effectiveness. Several alternative plans currently in place, including the Canadian system, are discussed and compared to this proposal.

Planning, Cost shifting (Medical care)

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