Controlling costs by 'managed competition' - would it work?

Article Abstract:

The idea of 'managed competition' as a means of expanding access to health care while controlling costs has gained favor with many, including President Clinton. The principle behind managed competition is that managed care organizations such as health maintenance organizations (HMO) would compete for insurance contracts with employers, Medicare and Medicaid. The costs of the lowest-priced approved plan would be tax-deductible, and costs beyond that would be covered by the individual or employer. HMOs have had only intermittent success in lowering costs and no success in containing medical inflation, so the question remains as to whether managed competition would work any better. It is possible that instead of reducing costs, managed competition might promote high, but standardized, costs. The larger issue, though, is of quality. Cutting back on services would appease profit-driven insurance companies and would be difficult to monitor. The problem with managed competition is that cost and quality control measures rest with insurers, not physicians and patients.

Management, Evaluation, Medical care, Cost of, Health care costs, Managed care plans (Medical care), Health maintenance organizations

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The NIH "E-biomed" proposal -- a potential threat to the evaluation and orderly dissemination of new clinical studies

Article Abstract:

The "E-biomed" database proposed by the National Institutes of Health may have a serious impact on medical publishing. The NIH proposed this database of scientific reports to give authors a chance to publish an article that might not be accepted by a traditional scientific journal. The article would still be reviewed by two members of E-biomed's governing board. Comments on the article could also be posted on E-biomed. This could have a significant financial impact on scientific journals, many of which already perform many of the functions E-biomed would perform.

Innovations, Electronic publishing, Ethical aspects, Information services, United States. National Institutes of Health, Journalism, Medical, Medical journalism

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