Health care: overpriced, unjust - and unlikely to change

Article Abstract:

The health care system in the United States is often criticized for being too costly and excluding too many persons. However, this problem is difficult to solve because of federal budget restrictions, lack of political agreement, and influence of special interest groups such as doctors, insurers, employers, and labor. The rising health care costs reduce the ability of the US to compete in the international market and to maintain a high standard of living for its citizens. Health care has become a primary concern in collective-bargaining negotiations. Several approaches have been proposed to contain costs as well as provide care to uninsured Americans. They include promotion of health through drug, alcoholism, and improved diet programs; tax credits for poor families to help buy insurance; malpractice reform to prevent doctors from providing excessive care; and regulation of the insurance industry. Some issues addressed by Congress include health care for the uninsured, long-term care for the elderly, the cost of national health assistance, provision of medical coverage by employers, and federal support for the chronically ill. A $25 billion cut in Medicare through reducing fees to doctors, hospitals, and other medical care providers was proposed. However, providers would charge more to privately insured patients to offset the loss. Doctors, pharmaceutical firms, and the hospital industry make large contributions to political candidates and can influence the development of government health care policies. The public wants the federal government to bear some of the costs of medical insurance, but is unwilling to pay higher taxes or have limited choice of physicians. Most groups agree that: (1) every American is entitled to medical care; (2) every provider should be reasonably compensated; and (3) all Americans should contribute to support of the health care system. In the future, most persons will receive some type of health coverage and the private insurance industry will be more regulated by the government. The medical profession can help to solve the health care problem by returning to the "Samaritan tradition" and considering medicine as a social service rather than an economic good. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules

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The future and role of chiropractic in managed care and cost containment

Article Abstract:

Health care costs rank third in household expenses in the United States. Health benefits paid increased from $604 billion in 1989 to $676 billion in 1990. The increase is due to general inflation, more frequent use of medical services, health care-specific inflation, and population changes. Health care costs are estimated to increase by $1.5 billion over the next 10 years. Chiropractic care accounts for $8-9 billion per year, and the use of chiropractic services is also increasing. Although Americans spend the most on health, they still do not have optimal health as a result, and 32 million Americans are without adequate health coverage. The quality and accessibility of care can be improved by reducing costs of unnecessary or ineffective procedures through managed care. Most Americans believe that the government should spend more on health care. In the American fee-for-service system, in which the patient does not pay the major portion of premiums or physician fees, the patient and physician tend not to conserve resources. The rise in employer spending for group insurance threatens the financial stability of many businesses, and many companies have adopted new ways of containing health care costs, such as managed care. As in other health professions, the use of unnecessary of ineffective procedures in chiropractic care is continually under scrutiny. Managed care is a system in which physicians, employers, insurers, and employees work together to improve the quality, efficiency, and cost-effectiveness of health-care resources. Various aspects of managed care are discussed. In addition, five ways in which the chiropractic can successfully integrate within managed care are described. They include: (1) understanding managed care; (2) education of the public and health professionals regarding managed care; (3) continued development and publication of scientific research; (4) development of standards for practicing chiropractic care; and (5) quantitative assessment of the effectiveness and quality of managing patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Chiropractic and insurance: working within the system

Article Abstract:

Twelve years ago, filing insurance claims was not difficult for chiropractors. Insurance forms were often filed as a courtesy for the patient, and codes were not always used. A simple statement of office visit describing adjustment/manipulation, therapy, and examination seemed adequate for payment. Gradually chiropractors were required to break down or further classify the office visit. The process of filing insurance claims has now become more time consuming, involving large amounts of paperwork. The development of the managed-care industry resulted from a need to control health care costs. Heath care has increased by 9 to 12 percent each year, and it is predicted that 50 to 75 percent of all health care will be classified as a type of managed care. Other health professionals must deal with managed-care issues. However, the chiropractic profession is often not considered part of the health care industry, and chiropractors must fight for coverage with any form of managed-care system. The Task Force on Managed Care was established to ensure that chiropractic care is available to patients. The American Chiropractic Association (ACA) Insurance Relations Commission developed a video for practitioners to present to insurance personnel. The video addresses key issues concerning chiropractic care and problems related to coverage. Recommendations are made to ensure better communication between the practitioner and insurance carrier or third-party payor. They include avoiding the use of multiple confusing diagnostic codes; proper reporting; avoiding the use of unnecessary repeated testing; acceptance that patients will eventually be dismissed from care; and the maintenance of an open and friendly dialogue with the adjustor handling the case. Thus, chiropractors must make efforts to be cost-effective in their practice to become successful in the new managed health-care system. (Consumer Summary produced by Reliance Medical Information, Inc.)

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