A national health program: abyss at the end of the tunnel - the position of physicians who care

Article Abstract:

In the October 20, 1989 issue of The Journal of the American Medical Association, a commentary asserted that the solution to the crisis in the US health care system is the creation of a national health program similar to the Canadian system. However, several problems have developed in Canada where compulsory universal health care has resulted in a severe money shortage and expenses that continue to rise. This dilemma has caused an enormous drain on the government's budgetary resources and a serious shortage of available hospital beds. The Canadian system remains underfinanced, precipitating a new crisis and much political debate, with some arguing that the quality of the entire health care system has been jeopardized. It is unlikely that the US government will institute a similar system in the near future, given its existing budget deficits. However, two possible scenarios are proposed. The first emphasizes funding health care for the poor; government funds would be derived from increased taxes. Health care would be available to all, and independent practice would disappear. An effective system would need to be implemented to reward or punish doctors, based on their performance. The second scenario involves a one-payer system created by the government. As funds are depleted (and they would be), patients would seek private care, and the quality of publicly available services would decline. The quality of medical students would also decline as the practice of medicine would become less attractive. American physicians are now in a position to influence the choices that will be made in formulating a new health care system in this country. The question remains as to whether or not they will exert a positive influence or remain on the sidelines. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Political aspects, Health planning, editorial

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The Health Security Partnership: a federal-state universal insurance and cost-containment program

Article Abstract:

The Health Security Partnership was developed by the Committee for National Health Insurance to address the issues of equal access and core benefits. Central to the problems of medical care are cost and quality control, and as corollaries, independence of clinical care from micromanagement, and patient choice in clinical decisions. The Health Security Partnership believes that the care system is more heterogeneous than at any other time, and that health care solutions must take this into account, and look to a state-based solution. The probability of widespread errors would be reduced, although the states may make mistakes. The federal government would define the core benefits, including necessary medical services, in-hospital drugs, and preventive services. State governments would decide on mechanisms to carry out the plan, which would be funded through taxes and insurance premiums. The role of private insurance would be determined at the state level. Federal, state, tax, and premium funds would go to a single state-designated agency, making it easier to track the size and sources of total health care expenditures, and to maintain a budget. These state budgets would help to ensure cost containment. The increased demand for services would cause inflationary pressures, but eventually administrative efficiency and cost containment would offset the price increases. The committee estimates a 5 percent increase in personal health care expenditures in the program's first year, to be shared equally by the federal and state governments, as well as the private sector. (Consumer Summary produced by Reliance Medical Information, Inc.)

Finance, Health insurance

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Patient-physician communication about out-of-pocket costs

Article Abstract:

Many doctors and patients want to discuss medical bills that patients will have to pay directly, but most do not. In a survey of 133 doctors and 484 of their patients, 63% of the patients wanted to discuss this topic and 79% of the doctors believed their patients would like to discuss it. However, only 35% of doctors and 15% of patients ever discussed this topic. Out of pocket medical expenses represent 20% of all health care costs and are a substantial burden for many people.

Physician and patient, Physician-patient relations

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