Biomedical subjects

W Higgins

Publications and source records attributed to W Higgins.

21 records · Page 2Linked to original sources

PubMedDate not supplied

Dominos that wouldn't fall: understanding the failure of competitive reform.

Ten years ago, there was widespread optimism that market competition would succeed in controlling health cost inflation and restructuring the health care industry in socially desirable ways. Today, many view competitive reform as a failed strategy. Costs remain uncontrolled and both government and private payers are turning to regulation and monopsony power. Formidable and longstanding barriers to price competition in the markets for health insurance and health care services were underestimated. Efforts to promote competitive reform were halfhearted and partially offset by a growth of regulation. What lessons can be learned from the competitive experiment and how will health policy evolve in the future?

Cost Control↗

PubMedDate not supplied

Rationing medical care.

Recent proposals to reform the health care financing system have sparked discussions concerning the need to ration health care. Relative to other western industrialized democracies, the US rations primary and preventive care more, tertiary care less, and makes greater use of price rationing and bureaucratic controls. Because insurance coverage is not universal and the extent of coverage varies across services, the poor and those patients needing long-term care are most heavily affected by price rationing. The current system also works to the advantage of procedure-oriented specialists and to the disadvantage of primary care physicians. Major reform of health care financing could change what is rationed, how it is rationed, and who is most affected. However, some rationing will remain necessary under any conceivable financing system.

Canada↗

PubMedDate not supplied

Supplementing managed competition.

President Clinton's proposal for health care reform calls for managed competition within global expenditure targets. However, it is unlikely that health plans will have sufficient leverage with providers to negotiate arrangements consistent with expenditure targets in nonurban areas. This paper describes a reimbursement system based on competitive prospective payment and capitation (CPPC) which can supplement managed competition in less populous areas or replace managed competition should that strategy prove unsuccessful. The CPPC system is capable of enforcing an expenditure target while encouraging the formation of capitated networks and creating strong incentives for efficiency. It is generally compatible with the Clinton administration's version of managed competition.

Capitation Fee↗