Insuring the uninsured is not enough

Article Abstract:

Although many Americans benefit from excellent health care, such care is not available to the nation's more than 30 million uninsured or underinsured people. The May 15, 1991 issue of The Journal of the American Medical Association was devoted to the problems of the underinsured, and articles in the May issues of specialty journals published by the American Medical Association focused on related topics. Some proposals made in these articles for improving health care coverage are explained and evaluated. Most discussed changes in the ways the main insurers (Medicare, Medicaid, employers) could provide coverage. More than three-quarters of the American uninsured are workers and their families who cannot afford medical coverage. However, insuring these people is not enough: a better goal is guaranteeing universal access to quality health care. Medicaid, the plan for the poor, has failed; it excludes most low-income men and couples who are childless, and spends almost half its funds for long-term care of the elderly, the mentally ill, or the mentally retarded. Some proposals suggested establishing a national health program financed by taxes, but passage of a tax increase sufficient to raise the necessary $250 billion seems unlikely. Basic health care should include all care that is medically needed to people in all areas of the US, and the care should be of high quality. Several proposals suggested cost containment strategies aimed at consumers, providers, or payers. The authors believe that providers (in particular, physicians) should bear the main responsibility for cost containment. Medical services should be decreased, and patterns of medical practice should be based on outcome assessment. Furthermore, the number of patients requiring expensive treatment can be decreased by improving preventive approaches. Finally, many terminally ill patients receive the benefits of costly technologies they do not want; money could be saved by wider use of living wills and by curtailing treatment for those who do not desire it. Careful evaluation of priorities can lead to a situation where all Americans can obtain good health care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Finance, Services, Medical care, Medically uninsured persons, Health insurance, editorial

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Community-based plan for treating human immunodeficiency virus-infected individuals sponsored by local medical societies and an acquired immunodeficiency syndrome service organization

Article Abstract:

In the 10 years that AIDS has been recognized, over 130,000 cases have been reported in this country. Some members of the medical community have been reluctant to care for AIDS patients for several reasons, including their own fears of acquiring the disease, the cost of treating these often uninsured patients, and lack of confidence in treating a complex and new disease. Some physicians in private practice fear the loss of other patients, as at least one public opinion poll reported that up to 25 percent of healthy patients would leave their own doctors' practices if they knew that their physicians were treating patients with AIDS. In the geographic area centered in Norfolk, Virginia, recognition of the difficulty that local AIDS patients had in finding physicians who would care for them led to a cooperative initiative between local medical societies and local AIDS activist and support groups to encourage more private physicians to care for these needy patients. The coalition referred a few AIDS patients to each physician who was willing to provide care, with no more than three AIDS patients being assigned to any one physician in a given year. As the program developed, care was taken to assign patients rationally, so that the degree of illness and the patient's and physicians's financial status were taken into account. Most of the physicians who signed up for the program have continued to provide care for the patients over the three years the program has existed, and a few more sign on each time the program is publicized. A few dentists in the area have also begun to provide care for patients with AIDS. Discrimination is still encountered in nursing homes and among funeral directors, but the coalition of medical and community groups is addressing these issues. This program might serve as a model for other small- to medium-sized communities that wish to provide quality care to the persons with AIDS who live in their areas. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Care and treatment, Evaluation, Virginia, Community health services, AIDS patients, Health care coalitions

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The cost of acquired immunodeficiency syndrome in northern California

Article Abstract:

The cost of medical care for patients with AIDS (acquired immunodeficiency syndrome) in the Kaiser Permanente Medical Care Program (KPMCP), which is located in northern California, was assessed. There were 886 AIDS cases between the beginning of the AIDS epidemic in 1981 and the end of June 1987 among members of KPMCP. Medical care costs were assessed from chart reviews of 71 patients who were diagnosed with AIDS between January 1984 and June 1987. It was estimated that the total average cost of medical care over the lifetime of a patient with AIDS was $32,816, and the hospital costs per day was $20,446 for each patient with AIDS. Overall costs decreased as medical care was shifted toward outpatient services, despite large increases in the costs of medications such as zidovudine. These estimates were similar to those determined by others for the cost of AIDS-related medical care in San Francisco, California. However, these cost estimates are lower than those observed in other parts of the country. This is probably due to the smaller number of AIDS cases related to intravenous drug abuse and the well-developed social support systems for AIDS patients in the San Francisco Bay area. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Prices and rates, California, Hospitals, Hospital rates

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