Healthcare tickets for the uninsured: first class, coach, or standby?

Article Abstract:

In an effort to provide healthcare insurance for everyone, many plans have been proposed. Among them are to allow the consumer to select health plans using employer-based insurance and to expand the current Medicaid program. Most of these programs focus on funding and reducing costs, and not on what the policies will and will not cover. The proposed expanded Medicaid program, Health Policy Agenda (HPA), suggests covering all expenses. However, the sources for these funds are limited and current expenditures are already substantial. A cost-containment approach would restrict eligibility and services and improve system efficiency. It is suggested that statewide policies be abandoned to allow programs to be based on the healthcare needs at the local level. Another suggestion is to grant Medicaid participants freedom of choice in selecting the provider through enrollments in Health Maintenance Organization (HMOs). Oregon proposed a health services priority list for the entire population, in which the number of people covered is considered a more important issue than the number of services covered. It is suggested that similar policies should be implemented in all states. Services having the highest priority were family planning services, which include the care before, during and after infant delivery. Lowest priority was given to infertility services, plastic surgery, routine dental care and organ transplantation. All-care insurance that covers everything makes promises that cannot be kept, and compromise is needed.

United States, Analysis, Medical economics, Economic aspects, Medically uninsured persons, Health insurance, Insurance, National health insurance

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Questions about the value of early intervention

Article Abstract:

It may be time to question the assumption that intensive medical care in the early stages of disease is always beneficial. A 1996 study at nine Veterans Affairs Medical Centers found that intensive follow-up of patients with diabetes, heart failure and lung disease after hospital discharge actually increased readmission rates rather than reducing them. These patients had 70% more visits to general medical clinics and were seen earlier following their discharge than those in the control group who received standard care after discharge. A lower readmission rate in the control group occurred despite the fact that these patients had more severe disease in many cases. Mortality rates were actually higher in the group that received intensive intervention. Intensive intervention may identify more problems that the medical care team will feel compelled to treat. This could lead to higher hospitalization rates and higher mortality rates.

Health aspects, Editorial, Medical care

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The use of Medicare home health care services

Article Abstract:

Many states are using the Medicare home health care service to provide long-term care rather than as a transition from hospitalization. The Medicare home health care service was originally authorized only for people who had recently been hospitalized. Analysis of 1993 data from the Medicare National Claims History File revealed that 3 million Americans received over 160 million home health care visits. Forty-three percent had not been hospitalized in the previous 6 months. There was a wide geographical variation in the use of home health care services and no evidence that it reduced hospitalization rates.

Usage, Medical care utilization, Medicare, Home care services

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