Access to health care

Article Abstract:

The Health and Public Policy Committee of the American College of Physicians has published a major policy paper concerning the problems facing health care delivery and recommending solutions. The paper, published in the May 1, 1990 issue of the Annals of Internal Medicine, considers four major problems: the lack of access to health care, inadequate insurance coverage, rising costs, and the burden the current system places on patients, families, and physicians. Proposals include expansion of the use of private insurance by individuals and employers, and a mandatory package of insurance to be provided by employers. Another proposal suggests that "risk pools" could be developed among insurance companies to spread out the costs of high-risk groups, just as auto insurance companies now do for high-liability risks. The extension of Medicaid may provide a direct method of providing care for those who are poor but do not qualify for public assistance. The report also proposes that physicians expand voluntary charity care, but cautions that this care is not a substitute for other reforms, and that charity care patients usually receive less care and lower quality care. Perhaps the most far-reaching proposal is that a system providing universal access to health insurance be implemented. A single system of universal access may reduce the administrative costs now being spent in a fragmented system, costs which might better be applied elsewhere. Caution should be exercised, however, lest a universal health insurance program result in government intervention in the practice of medicine and perhaps even the overt rationing of health care. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Universal access to health care in America: a moral and medical imperative

Article Abstract:

In 1932, the Committee on the Costs of Medical Care, a privately funded group, stated that the quality of medical care is an index of a civilization. At that time, there was little health insurance and the expectations of patients were not great. By the 1970s, however, all major industrialized nations had developed some system to ensure that all citizens had access to medical care, with one exception. That exception, of course, is the United States. There are still over 30 million Americans without health care coverage. About a third of those are children, and 55 percent are working adults, generally with low-paying jobs. The authors believe that attempts to rectify the more intolerable aspects of the problem may do some good, and certainly have some political appeal. But by and large, piecemeal attempts to change health care delivery will only be band-aids placed on a much larger problem. Major reforms are necessary. The present system has enormous administrative costs and is intrusive into the actual practice of medicine. Efforts to build upon the present system will fail to alleviate the problem, and may well make the problem worse. The authors believe that a fair and equitable health care system is possible; it must be designed on the basis of a national health policy, not as a patchwork quilt of attempted reform. (Consumer Summary produced by Reliance Medical Information, Inc.)

United States, Medically uninsured persons, editorial

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Some Things Have Not Changed

Article Abstract:

The author discusses an aspect of time constraints on physicians, the total number of pressures affecting the use of time. She counsels that looking back on the history of medicine and personal history can refresh insight into ideals, commitments and accomplishments. She presses for cooperation and collaboration between physicians, patients, staff, students, and other health professionals to create an environment of trust and healing.

Social aspects, Time, Physicians, Medical professions, Influence

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