Editorial. Be prepared for some form of a national health program.
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OBJECTIVE: To present the process in the design, development and implementation of Mexico's National Adolescent Health Program. MATERIALS AND METHODS: In efforts to arrive at a consensus regarding the health care priorities for Mexico's adolescent population, 37 public and private institutions dedicated to adolescent health care and social issues were invited to participate in a strategic analysis regarding a joint action plan for health promotion in adolescents with special emphasis on resilience as protective factor. The definition of the action plan involved the participation of 190 health professionals responsible for child and adolescent health programs in the discussion and drafting of the National Health Program. RESULTS: The steps and issues discussed by the 37 participating institutions leading to the development of the National Health Plan are reviewed. CONCLUSIONS: The product of this exercise led to the elaboration of a consensus document that served as the framework for Mexico's National Adolescent Health Plan and that now serves 23.5 million adolescents between 10 and 19 years of age. This action plan was been reviewed by the World Health Organization, which cited Mexico as one of the eight model countries addressing adolescent health.
Raab uses the National Health Planning and Resources Development Act of 1974(P.L.93-641)which designated state and substate regional planning agencies, as a departure for discussion of a larger issue: federalism. Administration of the law has raised issues about the allocation of power among national, state and local governments. The author tries to set this question in historical context by tracing the history of U.S. intergovernmental relations and highlighting key issues. He focuses on two perspectives of federalism: cooperative and competitive relations between governments. From this survey, Raab draws three conclusions: conflict has become "inevitable" as governments pursue their own objectives in administering national grants-in-aid; state and local officials have grown more concerned with administrative structure than the substance of policy; and the growth of lobbies for state and local governments has reduced the prospect of conflict.
Despite growing concern with cost containment, most health policy analysts have ignored vast potential savings on medically irrelevant spending for excess administration, profits, high physician incomes, marketing, and legal involvement in medicine. Indeed, many recent reforms encourage administrative hypertrophy, entrepreneurialism and litigation. A universal national health program could abolish billing and consequently the need for much of the administrative apparatus of health care, and decrease spending for profits and marketing. In this article we analyze the administrative savings that could be realized from instituting a Canadian-style national health insurance program or a national health service similar to that in Britain, and the potential savings from additional reforms to curtail profits, marketing and litigation. Our calculations based on 1983 data suggest that national health insurance would save $42.6 billion annually: $29.2 billion on health administration and insurance overhead, $4.9 billion on profits, $3.9 billion on marketing, and $4.6 billion on physician's incomes. A national health service would save $65.8 billion: $38.4 billion on health administration and insurance overhead, $4.9 billion on profits, $3.9 billion on marketing, and $18.6 billion on physician's incomes. Complete nationalization of all health related industries and reform of the malpractice system would save at least $87.2 billion per year. We conclude that a national health program, in addition to improving access to health care for the oppressed, could achieve cost containment without rationing of care.
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