PubMed Health⌕ Search

Biomedical subjects

T Bodenheimer

Publications and source records attributed to T Bodenheimer.

At least 19 recordsLinked to original sources
PubMed1999

Primary care physicians should be coordinators, not gatekeepers.

Primary care gatekeeping, in which the goal of the primary care physician (PCP) is to reduce patient referrals to specialists and thereby reduce costs, is not an adequate system in which to practice medicine. However, returning to the pre-managed care model of uncoordinated open access to specialists is a poor solution. The primary care model should be retained, but PCPs should be transformed from gatekeepers into coordinators of care, in which the goal of the PCP is to integrate both primary and specialty care to improve quality. Changes in the PCP's daily work process, as well as the referral and payment processes, need to be implemented to reach this goal. This model would eliminate the requirement that referrals to specialists be authorized by the primary care physician or managed care organization. Financial incentives would be needed, eg, to encourage PCPs to provide management of complex cases and discourage both over-referral and underreferral to specialists. Budgeting specialists should control excess costs that might be created by the elimination of the primary care gatekeeper. Pilot projects are needed to test and refine this model of PCP as coordinator of care.

Case Management↗
PubMed1999

Questions and answers about Medicare.

A premium support (voucher) proposal for Medicare will be introduced into the U.S. Congress in 1999. To explain this proposal to the public, the National Coalition to Protect, Improve, and Expand Medicare has published a report entitled "Rebuilding Medicare for the 21st Century." The lead author of the report here presents some questions and answers on the main topics under discussion.

Cost Control↗
PubMed1997

The logic of tax-based financing for health care.

Employment-based health insurance faces serious problems. For the first time, the number of Americans covered by such health insurance is falling. Employers strongly oppose the employer mandate approach to extending health insurance. Employment-based financing is regressive and complex. Serious debate is needed on an alternative solution to financing health care for all Americans. Taxation represents a clear alternative to employment-based health care financing. The major criterion for choosing a tax is equity, with simplicity a second criterion. An earmarked, progressive individual income tax is a fair and potentially simple tax with which to finance health care. The political feasibility of such a tax is greater than that of employer mandate legislation.

Health Benefit Plans, Employee↗