Health care reform: Difference between revisions
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Revision as of 11:54, 9 March 2010
Health care reform is "innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services."[1]
Individual states have not been able to reform health care.[2] Many proposals have been made in the United States at the national level for reform.[3]
Health care cost
Health care costs are "the actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost."[4]
Regarding the increases in cost of the health care sector in the United States, one cost-benefit analysis concluded, "on average, the increases in medical spending since 1960 have provided reasonable value."[5]
Sources of unnecessary costs
Administrative costs
The costs of administration of health care in the United States in higher than the costs in Canada.[6]
Conflict of interest
Doctors who receive income from referring patients for medical tests have been shown to refer more patients for medical tests [7]
Insufficient access to prior medical records
Sometimes diagnostic testing is redundant because of inadequate access to prior medical records.[8]
Proposed interventions
Increased preventive health care
Regarding the opportunity cost of primary prevention of diseases, one analysis concluded, "opportunities for efficient investment in health care programs are roughly equal for prevention and treatment."[9]
Improved availability of prior medical records
Having the results of prior tests available may reduce the need for repeating tests.[10] A randomized controlled trial has shown reduction in ordering of redundant tests.[11]
Place doctors on salary
Placing doctors on salary has been proposed to avoid the conflict of interest in the fee-for-service plans.[12][13][14]
Health services accessibility
Health services accessibility is "the degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others."[15]
Proposed interventions
The 1993 Clinton health care plan proposed a mandate that employers pay 80 percent of the average premium of health care plans for their employees.[16]
In 1976, President Carter proposed comprehensive national health insurance system with universal and mandatory coverage.[17]
In 1965,President Johnson proposed and implemented Medicare and Medicaid.[18]
In 1949, President Truman proposed national health insurance.[19]
Malpractice reform
Reform of medical malpractice is sometimes included as a component of health care reform.[20][21][22][23]Cite error: Closing </ref> missing for <ref> tag
Enterprise liability
The American College of Physicians has suggested demonstration projects test the feasibility of enterprise liability.[24][25]
Comprehensive proposals
Several alternatives are in the U.S. Congress, such as the Baucus bill introduced by the Gang of Six.
President Obama
President Obama summarized his plan.[26][20][22][27]
His House Bill is H.R. 3200 and includes an expansion of Medicaid.[28] The Congressional Budget Office has published their budgetary projections which states, "enacting H.R. 3200 would result in a net increase in the federal budget deficit of $239 billion over the 2010-2019 period."[29]
President Clinton
President Clinton summarized his plan.[16] The Clinton plan included mandatory:[30][31]
- states creating not-for-profit health care cooperatives or alliances. The alliances would approve health care plans that offer care paid by salary, capitation fee, or fee-for-service plans.
- employers paying 80 percent of the average premium of health care plans.
The Clinton plan was defeated, "the Senate Finance Committee did approve a bill in July 1994 that would have extended health insurance to 95 percent of the population by 2002, but the bill stalled in debate on the Senate floor and never came to a vote."[32] The defeat was interpreted as being "rejected by a public that came to see it as a bid to replace their family doctor with the Bureau of Motor Vehicles writ large."[32]
References
- ↑ Anonymous (2024), Health care reform (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Emanuel E, Wyden R (October 2008). "A new federal-state partnership in health care: real power for states". JAMA 300 (16): 1931–4. DOI:10.1001/jama.2008.536. PMID 18940982. Research Blogging.
- ↑ Goodridge E; Arnquist S. (2009) A History of Health Care Reform The New York Times
- ↑ Anonymous (2024), Health care costs (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Cutler DM, Rosen AB, Vijan S (August 2006). "The value of medical spending in the United States, 1960-2000". N. Engl. J. Med. 355 (9): 920–7. DOI:10.1056/NEJMsa054744. PMID 16943404. Research Blogging.
- ↑ Woolhandler S, Campbell T, Himmelstein DU (August 2003). "Costs of health care administration in the United States and Canada". N. Engl. J. Med. 349 (8): 768–75. DOI:10.1056/NEJMsa022033. PMID 12930930. Research Blogging.
- ↑ Swedlow A et al. (1992). "Increased costs and rates of use in the California workers' compensation system as a result of self-referral by physicians". N Engl J Med 327: 1502-6. PMID 1406882.
- ↑ Bates DW, Boyle DL, Rittenberg E, et al (1998). "What proportion of common diagnostic tests appear redundant?". Am. J. Med. 104 (4): 361–8. PMID 9576410. [e]
- ↑ Cohen JT, Neumann PJ, Weinstein MC (February 2008). "Does preventive care save money? Health economics and the presidential candidates". N. Engl. J. Med. 358 (7): 661–3. DOI:10.1056/NEJMp0708558. PMID 18272889. Research Blogging.
- ↑ Tierney WM, McDonald CJ, Martin DK, Rogers MP (1987). "Computerized display of past test results. Effect on outpatient testing". Ann. Intern. Med. 107 (4): 569–74. PMID 3631792. [e]
- ↑ Bates DW, Kuperman GJ, Rittenberg E, et al (1999). "A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests". Am. J. Med. 106 (2): 144–50. PMID 10230742. [e]
- ↑ Relman AS. (2009) Doctors as the Key to Health Care Reform. New Engl J Med
- ↑ Harris G (2009) Hospital Savings: Salaries for Doctors, Not Fees. New York Times
- ↑ (2009) Doctors Weigh in on Healthcare Reform CNBC
- ↑ Anonymous (2024), Health services accessibility (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 16.0 16.1 Clinton B (September 1992). "The Clinton health care plan". N. Engl. J. Med. 327 (11): 804–7. PMID 1501657. [e]
- ↑ (June 9, 1977) National Health Insurance: The Dream Whose Time Has Come? The New York Times
- ↑ Blumenthal D, Morone J (November 2008). "The lessons of success--revisiting the Medicare story". N. Engl. J. Med. 359 (22): 2384–9. DOI:10.1056/NEJMhpr0806879. PMID 19038885. Research Blogging.
- ↑ Toner, Robin. Ideas & Trends: Government Health Insurance; An Idea Whose Time Has Come? It Came in 1965.. The New York Times.
- ↑ 20.0 20.1 Obama B (October 2008). "Modern health care for all Americans". N. Engl. J. Med. 359 (15): 1537–41. DOI:10.1056/NEJMp0807677. PMID 18815388. Research Blogging.
- ↑ McCain JS. (2008) Access to quality and affordable health care for every American. New Engl J Med PMID 18815389
- ↑ 22.0 22.1 Obama B (October 2008). "Affordable health care for all Americans: the Obama-Biden plan". JAMA 300 (16): 1927–8. DOI:10.1001/jama.2008.515. PMID 18940980. Research Blogging.
- ↑ McCain JS (October 2008). "Making access to quality and affordable health care a reality for every American". JAMA 300 (16): 1925–6. DOI:10.1001/jama.2008.514. PMID 18940979. Research Blogging.
- ↑ (March 1995) "Beyond MICRA: new ideas for liability reform. American College of Physicians". Ann. Intern. Med. 122 (6): 466–73. PMID 7856998. [e]
- ↑ Petersen SK (March 1995). "No-fault and enterprise liability: the view from Utah". Ann. Intern. Med. 122 (6): 462–3. PMID 7856996. [e]
- ↑ Obama, B (August 16, 2009). Op-Ed Contributor - Why We Need Health Care Reform. The New York Times.
- ↑ Obama B (November 2007). "My cure for an ailing system. How I, as president, would achieve affordable, universal health coverage". Mod Healthc 37 (47): 21. PMID 18159809. [e]
- ↑ America’s Affordable Health Choices Act of 2009
- ↑ Congressional Budget Office - H.R. 3200, America's Affordable Health Choices Act of 2009.
- ↑ Angell M (November 1993). "The beginning of health care reform: the Clinton plan". N. Engl. J. Med. 329 (21): 1569–70. PMID 8413480. [e]
- ↑ Relman AS (November 1993). "Medical practice under the Clinton reforms--avoiding domination by business". N. Engl. J. Med. 329 (21): 1574–6. PMID 8204139. [e]
- ↑ 32.0 32.1 Wines, Michael; Pear, Robert (July 30, 1996). President Finds Benefits In Defeat on Health Care -. The New York Times. Retrieved on 2009-08-16.