HMOs still favor capitation, long-term trends show.
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America is in the midst of a consumer revolution. Whereas consumers used to rely on experts to make decisions on their behalf, expertise mediated by technology is increasingly put in the hands of consumers so that they can take control of factors that influence their lives. It has become clear that there is value in a benefit design strategy that encourages consumers to take advantage of the information available to them and to take more control over their care. Benefit design that incorporates clinical evidence and thoughtful incentives for the consumer can be a strategy for achieving both clinical appropriateness and cost effectiveness.
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With resources becoming scarcer, providers, payers, and governments alike are grappling with how to best use these resources to serve the American people. Should the focus be on caring for individual patients (microallocation)? Or should the focus be on how to best serve a group of people (macroallocation)? Whether tax monies or health insurance premiums, pooled resources are always limited resources. Macroallocation involves trade-offs and setting priorities, but in the end, rationing is an obligation.
Overwhelmed by the cost of paying for health coverage, many small employers see their only options as cutting coverage, cutting staff or going out of business--any of which is bad news for communities and hospitals. There are creative alternatives to traditional insurance, and experts advise small businesses to explore those before taking drastic steps.
Controversial legislation that guarantees health coverage for most private-sector workers was recently passed in California. Known as the Health Insurance Act of 2003, the legislation will most likely be subject to a variety of legal challenges. The author presents a comprehensive description of how the Act works and the constitutional challenges it may face.
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