Reforming the health care system

Article Abstract:

Americans need a better health insurance system, and one which costs less for administrative overhead and management. Costs of health insurance could be decreased by eliminating the cost of advertising and marketing, which are associated with a competitive free-market system. Except for 30 million Americans who use a Health Maintenance Organization (HMO) or other form of prepaid medical coverage, most individuals are covered by plans that rely upon a traditional fee-for-service approach. This method of payment is inherently inflationary and lacks a responsible fiscal control. The system responds neither to costs of private practice nor to the costs of institutions, and one result is a growing gap between the quality of care afforded to the rich and to the poor. What is needed is a simplified insurance system, which offers more incentive for efficiency. One proposal is for insurance to be rapidly converted to a prepaid coverage system that uses a not-for-profit model and is controlled by both physicians and subscribers. Individuals who can afford and wish to can still be free to provide their own insurance, which would not be tied to government or employment. Providing universal coverage for all Americans is a praiseworthy goal, but the ability of current insurance payers to afford the continued rise in costs that would come from universal coverage is doubted. Increasing the pressure on doctors to become part of particular groups would encourage them to increase the quality of their performance, and encourage a more conservative practice without the pressure of fee-for-service. The mix of generalists and specialists would also change to one where more generalist primary care practitioners would attend to most routine medical issues. This will necessitate changes in medical education and allocation of postgraduate training as well. Unless such policies are soon initiated, we will remain tied to an ever-growing inflationary spiral. A final issue is the conversion of an entrepreneurial American medical system, which now operates like any other commercialized system, to a socially managed, nonentreprenurial model. Only a comprehensive change is the medical system can be successful. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Health insurance, Health maintenance organizations, editorial

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The increased needs of patients in nursing homes and patients receiving home health care

Article Abstract:

The Medicare prospective payment system, instituted in 1983, had a significant impact on hospital care; the system reimburses hospitals based upon the patient's diagnosis, which encourages earlier discharge. There is some concern that this approach to containing medical costs will cause some elderly patients to receive inadequate care in the hospital or to be discharged before they are medically ready. Older patients are typically discharged either to home care or to long-term care facilities. These two settings may be receiving patients who need more health care at a greater skill level than previously. To study the impact of the Medicare regulations on long-term care and home health agencies, the medical problems of about 1,500 randomly-selected patients from 1982 and 1986 were contrasted. The Medicare patients in nursing homes that accepted many Medicare patients had substantially more medical and skilled nursing problems in 1986 than in 1982. Traditional nursing homes with few Medicare patients did not show this increase. The reverse was true for functional health problems such as difficulty eating or speaking; these increased in traditional nursing homes but did not change in Medicare facilities. All types of health care needs increased for Medicare patients receiving home health care services. In conclusion, from 1982 to 1986 patients in long-term care had substantially increased needs, and this trend appears to be due to the Medicare prospective payment system. (Consumer Summary produced by Reliance Medical Information, Inc.)

Finance, Nursing homes, Home care services

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U.S. medical practice before Medicare and now - differences and consequences

Article Abstract:

In 1965, Medicare, a program of limited national health insurance, was established and resulted in major changes in the conditions of medical practice in the United States. With the establishment of Medicare, hospital trustees are now legally responsible for the quality of services performed at the hospital. The Blue Shield companies are less controlled by the medical community. Federal and state governments now have a great influence on medical practice because of their control over conditions and payment formulas for Medicare and Medicaid beneficiaries. Large corporations also have more influence on medical services, and medicine is now more of a business. Doctor's ethics, morality, and commitment to public service are legally controlled. Patients are more informed about medical matters and play a more active role in medical services. Although physicians are more competent and less negligent, there are many unfavorable consequences of the current Medicare program, such as the reduced number of personal care physicians, increased cost of medical services, continuing lack of medical care for some population groups and areas, the commercial exploitation of health care, the tight control of state and federal bureaucracies, and disaffection of doctors. Changes must be made in the current national health insurance program, and doctors must organize in order to resolve their differences and defend their interests. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medicine, Laws, regulations and rules, Practice, Physicians, Medical professions, Medical practice, column

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