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PubMed1997

Review of universal health insurance: should we try it?

Health care delivery and finances are fragmented in the United States resulting in inaccessible services to many in need. Other countries with universal health insurance have developed systems that provide basic care for all individuals while maintaining costs in a reasonable range. It is time to make tough decisions to enhance the public's health status and gain control over the destiny of medical practice, while considering the bottom line.

Delivery of Health Care↗
PubMed1989

A consumer-choice health plan for the 1990s. Universal health insurance in a system designed to promote quality and economy (2).

We describe the characteristics necessary for a plan for universal health insurance to find broad acceptance. Such a plan must represent incremental, not radical, change; must respect the preferences of voters, patients, and providers; must avoid major disruption in satisfactory existing arrangements; must avoid creating major windfall gains or losses; must avoid large-scale income redistribution; and must not be inflationary. Our proposal would create a framework that would encourage the efficient organization of care. Successful organizations would probably be those that attracted the loyalty and commitment of physicians, integrated insurance and the provision of care, and aligned the interests of doctors and patients toward high-quality, cost-effective care. The proposal's chief potential disadvantage would be its effect on the employment opportunities of low-wage workers, but this effect could be minimized. In addition, we discuss a proposal to mandate coverage by employers of full-time employees, legislation enacted recently in Massachusetts, high-risk pools, and the system followed in Canada, comparing each of these alternatives with our proposal.

Canada↗
PubMed1992

Including an all-payer reimbursement system in a universal health insurance program.

This article examines the feasibility of including an all-payer reimbursement system in a universal health care program in the United States. An all-payer system would keep intact the current array of private and public insurers, but would require that they each pay the same price for hospital and physician services. The article concludes that an all-payer system would face far fewer political barriers than a purely government-financed system. Furthermore, it has a number of advantages over the financing schemes currently used, particularly with respect to enhancing access to care and controlling costs. But there are several potential problems: agreeing on a common payment rate; controlling the volume of services provided; devising a way of incorporating alternative delivery systems; and dealing with the issue of whether providers will be able to "balance bill". The extent to which these problems can be solved will, to a large degree, determine whether an all-payer system can live up to its promise.

Cost Control↗
PubMed1990

Universal health insurance and high-risk groups in West Germany: implications for U.S. health policy.

Access to West Germany's broad-based health-insurance system is geared to the country's occupational structure. People who qualify, however, may seek coverage from alternative sources, including local "sickness funds." The changing nature of the German job market is leading to concentration of high-risk groups in the local funds, some of which could in turn face serious financial problems. Proponents of a universal health-insurance program for the United States need to take account of the growing segmentation of risk groups in the current German experience, which may ultimately threaten the concept of solidarity on which the system is founded.

Economic Competition↗
PubMedDate not supplied

Preparing health educators for the workplace: a university-health insurance company alliance.

The workplace is a relatively recent and an increasingly recognized setting for health education. In this article, philosophical and economic reasons for this movement of health education in the workplace are cited. Currently the workplace is one of the fastest growing markets for health education. In most institutions, preparing health educators for the workplace has not been adequately addressed. Consequently, an experimental course entitled "Health Promotion and Educational Strategies for the Workplace" was developed and taught at The Ohio State University in the summer of 1981. Besides an extensive reading list and lively class discussions, the course was team-taught primarily by a health education faculty member and a health insurance program manager/health educator.

Health Education↗
PubMed1989

A consumer-choice health plan for the 1990s. Universal health insurance in a system designed to promote quality and economy (1).

America's health care economy is a paradox of excess and deprivation. We spend more than 11 percent of the gross national product on health care, yet roughly 35 million Americans have no financial protection from medical expenses. To an increasing degree, the present financing system is inflationary, unfair, and wasteful. In its place we need a strategy that addresses the whole system, offers financial protection from health care expenses to all, and promotes the development of economical financing and delivery arrangements. Such a strategy must be designed to be broadly acceptable in our society. To remedy the deprivation, we propose that everyone not covered by Medicare, Medicaid, or some other public program be enabled to buy affordable coverage, either through their employers or through a "public sponsor." To attack the excess, we propose a strategy of managed competition in which collective agents, called sponsors, such as the Health Care Financing Administration and large employers, contract with competing health plans and manage a process of informed cost-conscious consumer choice that rewards providers who deliver high-quality care economically.

Centers for Medicare and Medicaid Services, U.S.↗