Financing medical care in the new Soviet economy

Article Abstract:

The Soviet Union is undergoing massive reform in its health care system, as well as its economic system, with the overall goal of making the system self-supporting through the addition of new resources. Eight United States health policy experts and physicians visited the Soviet Union in April 1990 to help outline a new health care plan, for which the phrase 'insurance medicine' has been adopted. A report of this visit is presented. Spending for health is estimated at less than 3 percent of the gross national product, compared with more than 11 percent in the US. Although the system is free to Soviet citizens, most pay additional monies under the table to guarantee access to services. Insurance medicine will attempt to garner new funding for health care from sources other than the central budget, the traditional source. Several enterprise- and consumer-funded medical insurance funds will be created; prices will be determined using marketing approaches; hospitals will be able to keep their revenues; and government-financed programs will care for groups such as pensioners and students. However, the mechanisms to put these reforms in place have not been defined. Questions to the US visitors regarding the applicability of the US system were answered with the suggestion that Canada might be a better model for the Soviet Union. Commitment to universal health coverage and access should not be abandoned, and the undesirable aspects of US medicine were explained to the Soviets. Five aspects of reform were established: the need for contributions from individuals and businesses; the need for decentralization; the importance of reallocation of health resources from richer to poorer regions; the need for a medical supply industry; and the importance of proceeding gradually. Cooperation between the US and Soviet Union in research, training, epidemiology, primary care, and other areas will be promoted. The scale of proposed changes in health care in the Soviet Union is great, and the reform proposals are ambitious. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical care, Soviet Union

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Medicaid at 30: new challenges for the nation's health safety net

Article Abstract:

Medicaid's expanded coverage to more disabled and poor people has increased spending and put a greater burden on financially strapped states and the federal government. Medicaid program costs have doubled over the last five years. Spending increased from $51 billion in 1988 to $125 billion in 1993. In 1993, Medicaid covered 32 million people. Medicaid provides health insurance for 60% of those in poverty, one in four children and many nursing home residents. The elderly account for 59% of Medicaid spending and accrue average costs of $8,704 per enrollee compared to $955 for each child on Medicaid. Congress wants to cut Medicaid spending to save $175 billion over the next six years. The 18% reduction in funds would place more pressure on public hospitals to care for the poor and disabled. Without Medicaid, the number of uninsured would greatly expand beyond the current 41 million.

Statistics, Medicaid

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Government

Article Abstract:

Congress has changed its attitude on health care reform. Members believe their constituents saw reform as someone else's problem because they were insured. By fall of 1991, health care was a national issue of more importance than national security and the economy. It ranked with education, poverty and homelessness. This change is not due to a rising number of uninsured citizens but due to their fear that their health insurance will no cover the rising costs of care. Many proposals for health care reform have been published. They range from those that will force all employers to insure their employees to those that would implement national health insurance. One limiting factor is the tremendous increase in taxes needed to implement even the mildest reforms.

Planning, Medically uninsured persons, Health care reform, Insurance

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