The Physicians Who Care plan: preserving quality and equitability in American medicine

Article Abstract:

The National Organization of Physicians Who Care does not believe that a health care system based on the Canadian model will work in the United States. Instead, this organization proposes a reorganized system based on the current mix of private and public funding, with five major elements. The cornerstone is employer-provided, community-related insurance with a $1,000 deductible. Second, individual ''Medi-Save'' accounts, to which individuals would contribute $300 to $500 per year as a form of self-insurance. Third, funding for Medicare, an ''entitlement'' program subject to government cuts, could be partially increased through medical individual retirement accounts (IRAs), to be purchased for every child in its first year of life. A $125 purchase (subsidized by the government for low-income families) at 10 percent interest would be worth $65,000 when the person reaches 65 years of age. This sum could be used to supplement or replace government health care spending. Fourth, Medicaid must be reorganized. Although the number of people receiving Medicaid increased by 9 percent during the 1980s, expenditures rose by 123 percent. Medicaid is in crisis, and hospitals are suing over lost revenue. One remedy is to take long-term care out of Medicaid and change eligibility requirements. Long-term care should be handled differently for the whole population. Fifth, scientific guidelines should be established by physicians, not insurance companies, for medical care. Finally, Physicians Who Care recommends that physicians disclose their financial interests, citing financial incentives to limit care in for-profit health maintenance organizations (HMOs), which undermine the freedom of the physician to base decisions solely on the good of the patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Models, Canada, Reports, Social policy, Medical care, Cost of, Health care costs, Medicaid, National health insurance

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Recombinant erythropoietin and Medicare payment

Article Abstract:

Erythropoietin is a hormone released by the kidney that stimulates red blood cell production. In 1989 Amgen, Inc. received exclusive approval from the Food and Drug Administration (FDA) to market recombinant erythropoietin to treat chronic renal (kidney) failure. Treatment for certain types of anemia was approved by the FDA in 1991. At the same time, the FDA allowed Ortho Pharmaceutical Corp. to distribute Amgen's product. The FDA's policy has led to lawsuits regarding patents and the seven-year exclusive marketing rights granted under the Orphan Drug Act. Both Genetics Institute and Chugai Pharmaceutical have challenged the FDA's award to Amgen. Federal policies have caused even greater controversy in regard to the provision and effectiveness of erythropoietin treatment. Medicare has established guidelines to try to keep expenditures down, providing a revealing study of the influence of federal policies on the availability, use and cost of medical technologies. Medicare payment policies, which mandate a fixed rate per treatment, have helped to keep treatment costs below those of most other countries. At this rate, dialysis centers break even on lower doses of erythropoietin, but lose money at higher doses, resulting in a situation where the effectiveness of the treatment falls below the potential effectiveness found in clinical trials at higher dosages. Various payment policies are discussed, and their effects are analyzed. There are strong incentives for providers to skimp on erythropoietin dosages, and the Health Care Financing Administration (HCFA) has failed to monitor dose-response relationships. The result is that thousands of Medicare beneficiaries were given ineffective doses of erythropoietin for many months. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prices and rates, Contracts, United States. Centers for Medicare and Medicaid Services, Erythropoietin, Recombinant, Recombinant erythropoietin

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Medicare funding of nurse education: the case for policy change

Article Abstract:

Most Medicare funds for nursing education appear to support small, hospital-based, preprofessional training programs. Researchers analyzed Medicare data, hospital characteristics, and nursing school enrollment statistics to study Medicare funding for nursing education. In 1991, Medicare payments to hospitals for nursing education totaled $174 million and are expected to increase to approximately $420 million by the year 2000. Medicare is the greatest source of federal funding for nursing schools. Of 1,484 nursing programs, only 372 received Medicare funding. Hospitals with diploma nursing programs received 66% of the funds, although they produce fewer than 10% of nurse graduates. Nearly half of Medicare payments for diploma nursing education went to hospitals in Pennsylvania, New Jersey, and Ohio. The average yearly Medicare payment to hospitals with diploma nursing programs was $5,028 per student in 1991.

Nursing schools

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