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Biomedical subjects

A C Enthoven

Publications and source records attributed to A C Enthoven.

At least 37 records · Page 2Linked to original sources
PubMed1991

Universal health insurance through incentives reform.

Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.

Aged↗
PubMed1990

Multiple choice health insurance: the lessons and challenge to employers.

This paper offers a second opinion on the issues discussed by Stanley B. Jones in his paper, "Multiple Choice Health Insurance: The Lessons and Challenge to Private Insurers" in the Summer 1990 issue of Inquiry. Multiple choice of health plans is not containing costs of health care or insurance premiums because employers have not yet tried price competition with cost-conscious consumer choice. HMOs in multiple choice arrangements have not saved employers money because of the way employers manage competition. Effective management of competition must be an active process employing an array of tools to create incentives that reward production of high quality economical care.

Community Participation↗
PubMed1989

What can Europeans learn from Americans?

In a wide-ranging look at many aspects of health care financing and delivery, the concepts of glasnost and perestroika are used as a framework for presenting ideas from the American system that may have value for European health care planners. These include more uniform approaches to data collection and cost reporting, patient outcome studies, evaluation of service and access standards, publication of information, quality assurance review, decentralization and independent institutions, prepaid group practice, demonstrations and experiments, and managed competition. Suggestions are offered for making health care systems on both sides of the Atlantic more manageable, efficient, and responsive.

Cross-Cultural Comparison↗
PubMed1987

The U.S. health care economy: from guild to market in ten years.

The U.S. health care economy is changing with remarkable speed from the non-competitive guild system of the past 50 years to a competitive market stem. A more efficient industry, more responsive to consumer preferences, is emerging. National health care expenditures grew from 5.3 percent of GNP in 1950 to 10.7 percent in 1983. Three factors that were especially important contributors to this are now being changed. The first is the fee-for-service method of payment of providers. The second is the principle of 'free choice of provider', a medical-economic concept designed to assure that the payor has no bargaining power and that there will be no economic competition among doctors. The third is that most government subsidies were open-ended subsidies of marginal costs. Important changes took place in the early 1980s, and additional changes appear inevitable, that will bring the open-ended era to an end. These changes are setting in motion an accelerating process that seems sure to change the whole system of health care finance from fees for individual items of service reimbursed after the fact, to prospective payments for global units of care, with providers at risk for their use of resources, and from cost-unconscious 'free choice' of provider to cost-conscious choice among limited groups of selected providers contracting in advance. The likely outcome of the process appears to be consolidation of the medical care system into comprehensive health care financing and delivery organizations serving, perhaps, several hundred thousand to several million people each.(ABSTRACT TRUNCATED AT 250 WORDS)

Economic Competition↗
PubMed1986

Managed competition in health care and the unfinished agenda.

A market made up of health care financing and delivery plans and individual consumers, without a carefully drawn set of rules to mitigate market failures, and without mediation by collective action on the demand side, cannot produce efficiency and equity. The concept of competition that can achieve these goals, at least to a satisfactory approximation, is managed competition, with intelligent active agents on the demand side, called sponsors, that contract with the competing health care plans and continuously structure and adjust the market to overcome its tendencies to failure. A great deal remains to be done to achieve the goals envisioned by the "procompetition reformers."

Economic Competition↗