Restructuring health care in the United States: a proposal for the 1990s

Article Abstract:

The Medical Schools Section of the American Medical Association proposes a pluralistic approach to comprehensive health care system reform through the implementation of a set of broad strategies. Medicaid must be restructured and reformed so that it benefits all the poor and near-poor. It should not provide long-term inpatient care for the severely disabled or elderly, which should be covered at the state level using local revenues from Medicare. Universal health insurance must be made available through employers. Regional group plans would serve the self-employed or medically uninsurable. These plans should provide long-term care options, and should be considered health insurance benefits for inclusion as individual tax deductions. Cost containment begins with individuals, who must take greater responsibility for their own health care, including adopting a healthy life style, bearing the cost of purchasing life insurance according to their means, and making copayment and first-dollar deductible payments for medical services they use. The government's responsibility should be limited to paying for those citizens who cannot afford to pay for health care. The second component of affordable universal access to health care is reform of the pricing and payment system, based on the diagnosis related group (DRG) system. A Resource-Based Relative Value Scale (RBRVS) should be the basis for physicians' fees. Quality of care through improved clinical decision making and practice patterns must be a part of the plan. Three broad strategies and two legislative measures to ensure quality control are outlined. Regional health insurance agencies, and primary care services are also discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Planning, Laws, regulations and rules, Statistics, American Medical Association, Health insurance, Medical care, Cost of, Health care costs, National health insurance

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A cross-national comparison of generalist physician workforce data: evidence of US supply adequacy

Article Abstract:

The U.S. appears to have an adequate supply of generalist physicians, and it is unnecessary to implement policies to increase this supply. Researchers compared generalist physician-to-population ratios in the U.S. with the ratios in Canada, England, and Germany, which are countries considered to have an adequate generalist physician workforce. The U.S. had 69 generalist physicians per 100,000 population; Germany had 66-95 per 100,000 population; England had 54 per 100,000 population; and Canada had 104 per 100,000 population.

Demographic aspects, Physicians (General practice), General practitioners

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Teaching Professionalism in Undergraduate Medical Education

Article Abstract:

Many medical schools do not teach students the principles of professional conduct. In a survey of 116 US medical schools, 90% said they offer some training in professionalism. However, half did not have a method of assessing the students' professional behavior. Many did not cover all four of the most important qualities of a medical professional including subordinating one's self-interests, adhering to high moral standards, responding to the needs of society, and developing a set of core humanistic values.

Medical students, Training, Study and teaching, Professional ethics

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