[Time to co-ordinate health care! Health control methods for integration].
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Health insurance plans are evaluated here in terms of ability to guarantee financial access to a set of basic fertility-related health services. Extent of coverage is determined by whether a service is a contract benefit, its market cost, and how often it is used in a given population in one year. Comprehensive coverage removes a deterrent to utilization of preventive care such as well-baby visits, prenatal care, and family planning. In a total population of women of child-bearing age, each is likely to need some fertility-related care in a given year. The method of calculating adequacy involves using best available estimates of deliveries, abortions, etc. per 1,000 women, and, within each category, of components such as cesarean section. Local or national cost data can be used to derive an average cost per service and an aggregate for a group. The method of comparing this with plan benefits depends on the way benefits are expressed. Jacksonville, Fla. medical market data were used in a trial of the method on a plan for Federal employees, which shows 70 per cent coverage of estimated expense.
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This article summarizes a new methodology recently developed by the Rand Corporation which permits health planners to assess the impact of the local health care system on the health status of the population. The methodology, in algorithm form, should assist health planners in developing objectives and actions related to the occurrence of selected health status indicators and should be amenable to health care interventions. Emphasis has been placed on developing a simplified, approximate analysis that health planners will find both feasible and effective. No detailed mathematic analyses are called for. The data required are, in most instances, readily obtainable. The algorithm is a methodology by which HSAs can investigate determinants of health status, identify breakdowns in the health care system, and specify needed improvements in the system. The goal of these algorithms is to assist HSAs to obtain valid and sufficiently detailed data that will provide a basis for monitoring breakdowns in the health care system and to improve planning decisions aimed at preventing such breakdowns. This should, in turn, affect population health status in the planning area.
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