A health policy agenda proposal for including the poor

Article Abstract:

Medicaid was implemented to bring health care to the poor of the country, but many low-income families fail to meet the eligibility criteria. Nearly 11 million individuals with incomes below the federal poverty line do not have health insurance and approximately half of these individuals are not eligible for Medicaid. Although charitable and public facilities are available in some locations, 19 million individuals have difficulty in obtaining needed health care because of their financial situation and one million are denied health care because they cannot afford it. Another article in the February 17, 1990 issue of the Journal of the American Medical Association discusses the problems and costs to society of providing a standardized health insurance package to most of the uninsured poor. Currently, there are great variations on a state-by-state basis regarding Medicaid eligibility and benefits, and the eligibility of the individual to other public welfare programs. The Health Policy Agenda Ad Hoc Committee on Medicaid has proposed eight major reforms in Medicaid, including: Medicaid to be restructured to National goals; linkage to welfare assistance be broken; adopt a 'spend down' eligibility system to support individuals paying for catastrophic medical bills; standardize benefits by federal mandate; expand measures to promote cost-effective delivery of service; encourage health-care provider participation; shift costs to federal government; and continue long-term care. The cost to undertake a major increase in providing individuals with Medicaid would require shifting funds within the total system; significant increases in spending will be required. Although much of the discussion concerning these changes centers on economic factors, the American commitment to providing universal health care needs discussion and clarification. This commitment to care must be supported or the poor may well fail to be included in the nation's health care agenda.

Planning, Finance, Health insurance, Medical policy, Health policy, Medicaid

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Health care in crisis: a proposed role for the individual physician as advocate

Article Abstract:

Even though universal access to health care is a goal of this society, one in seven Americans has no health insurance, and many more have inadequate insurance. Working people are often not provided with insurance, and minorities, women, the elderly, children, and the handicapped are among the most vulnerable. The United States rates nineteenth, behind all other industrialized nations, in infant mortality partly due to lack of access to prenatal care. Individual physicians should treat the poor and also become involved in social advocacy. A framework is presented to demonstrate how physicians can engage in efforts to combat the health care deficit. The first suggestion is to think like an advocate and to examine accepted beliefs. Physicians must also recognize that institutions, practices, and physicians themselves are the health care system, and also that individual, local efforts are worthwhile. Institutionalized poverty is a part of this society, and physicians can devote a percentage of their practices to care for indigent and Medicaid patients, or they can volunteer at a community organization. In addition to treating the poor, it is necessary to talk to them and to listen to them. Pharmaceutical samples can be saved for those patients who cannot afford to have their prescriptions filled. Physicians should be active on a broad range of public policy issues, and should engage others in social causes, including children's issues such as safe housing and nutrition programs. These suggestions will not produce a solution, but they do answer the question of what one individual can do. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physicians, Medical professions, Beliefs, opinions and attitudes, Social action

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Adherence to prescribed explicit criteria during utilization review: an analysis of communications between attending and reviewing physicians

Article Abstract:

Many physicians may not agree with the criteria used in utilization review (UR). UR is a way of forcing physicians to follow practice guidelines in order to improve the quality of medical care or hold down costs. Physicians at a UR firm reviewed the cases of 96 physicians whose request to insert tympanostomy tubes in young children with suspected otitis media was turned down during the initial UR. The physicians agreed with the recommendation in 30 cases, but recommended tympanostomy tubes in 66 cases. Of these 66, 71% had been deemed inappropriate initially. And the initial criteria were actually more lenient than other published guidelines on otitis media.

Care and treatment, Usage, Evaluation, Medical care, Practice guidelines (Medicine), Medical care utilization, Otitis media

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