An American approach to health system reform

Article Abstract:

The Canadian health system and the Pepper Commission report on health care are described, and the two are combined to build a model guaranteeing all Americans access to basic health care. Universal coverage should be achieved through expansion of both the public and private sector. Employers should be required to provide health insurance or to pay a tax for a general fund to finance a backup program for the uninsured. The amount of the tax can be adjusted to shift coverage between private insurance and taxation. The insurance industry must be similarly revised. Larger subsidies for the poor are proposed than those sought by the Pepper Commission, administered at the state level. Medicare would remain unchanged, although cost-containment policies need to be implemented. Medicaid would be replaced with a program covering workers whose employers pay the tax, the poor, and workers and nonworkers who buy into the plan. The costs of such a program would probably be borne in large part by the revenues it would generate. Costs would be controlled by giving the states a financial incentive to ensure that program costs did not grow faster than the GNP. The plan is largely acceptable because it retains the role of private insurance companies and employer-based coverage, as well as flexibility in cost-containment methods. There are still problems to be dealt with, including the burden on small businesses and low-paid workers. The states may object to increased responsibility, although it can be argued that small Canadian provinces have managed well. Finally, new tax revenues would be required at the state and federal levels. (Consumer Summary produced by Reliance Medical Information, Inc.)

Canada, Public opinion, National health insurance, United States. Bipartisan Commission on Comprehensive Health Care

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Understanding the recent growth in Medicare physician expenditures

Article Abstract:

During the 1980s, the total amount of money paid to physicians by Medicare increased substantially; the increases were 38.5 percent from 1987 to 1988, and 12.5 percent from 1988 to 1989. This growth in Medicare payments for physician services has raised concerns. It is not known why this trend is occurring, but many explanations have been suggested. The prospective payment system, which provides incentives to hospitals to discharge patients quickly, may have shifted various procedures into the domain of physician services. Physicians may be increasing the volume of services performed in order to offset the freeze on physician fees. Another possibility is that patients, who now make a smaller out-of-pocket contribution, are seeking more physician services. The aging of the American population may also be influencing Medicare payments to physicians. Medicare data for 1983 and 1985 were analyzed to investigate these possibilities. The study found that the 15 percent growth in expenditures for physician services between 1983 and 1985 was disproportionately rapid in regions with higher per capita income. In these areas, the newer, more expensive medical technologies were in greater use. Volume of services increased more rapidly for specialists utilizing the new technologies than for those who were not using them. Factors that did not play a significant role in the increased expenditures were the prospective payment system and its effects on hospital length of stay, and the freeze on physicians' fees. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Aged, Elderly, Analysis, Statistics, Health insurance, Medicare, Physician services utilization

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Can states take the lead in health care reform?

Article Abstract:

Several states have made major changes in their health care system, and others are discussing these types of changes. Many states have become frustrated with the slow process of health care reform at the federal level, and many state Medicaid programs are in crisis. States that have already implemented health care reform legislation include Hawaii, Oregon, Minnesota, Vermont and Florida. Oregon has received national attention because it is attempting to provide universal health care coverage for its residents. It is also trying to implement health care rationing. All of the states are concerned with providing health care to the poor and other individuals unable to obtain health care insurance. One major problem with implementing health care reform on a state level is lack of funding. States should be required to meet national standards for health care coverage and benefits, and they should also receive financial support from the federal government.

Planning, Health care reform, State government

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