Reinhardt "Reforming the health care system: the universal dilemma" American Jouranl of Law and Medicine, 1993; 19(1-2):21-36

Introduction

conflict between cost and care

insurers make the patients unhappy when sick (limit care) and unhappy when well (high premiums)

no ideal solution--everyone is unhappy with their system

Controling the Transfer of GNP to Providers

private or social good

eruope and canada--social

america--wandered between the two

Germany: not socialized medicine but socialized insurance

The Approaches Used in Canada and Europe

90% covered under government plans

supply side control by allocateing technology and facilities

price controls and/or expenditure caps to prevent abuse of the system

explicit payments negotiated through a few large pipes

do not look at the individual patient to control costs

since only 5% of the population accounts for nearly half of all health expenditures, it is reasonable to think of healthcare for the sick, not for everyone

lag time for new medical technology as its cost-effectiveness is evaluated

The Entrepeneurial American Approach

belife in demand control--by making consumers shop around for the best deal

shifting the cost onto the consumer--people are not as well insured as belived

managed care as the solution--limits patient choice and underserves patients

The Economic Footprints of these Approaches

America has few rivals elsewhere at both its best and its worst

The Cost of Health Care

massive surplus of beds in the US--provides incentives for unneeded care

growing at a disguisting rate

no care for the poor

The Uninsured

no where else is there so poor coverage for the poor

37 million unisured

profit pressures are forcing hosptials to reduce free critical care

Styles of Rationing

explicit rationing--by ability to pay (America)

implicit rationing--by judged medical need (elsewhere)

Summary of the Economic Footsteps

trade offs: freedom to organize production and price, degree of control over total expenditures, degree of equity in distribution

The Convergence of Health Care Systems

under older expenditure-driven financing of health care invention was the mother of neccesity--no attention to cost/benefit ratios

move towars "budged-driven deliver of health care"

others: constrain the physical capcity of the system, control prcies, impose global monetary budgets

Conclusion

cost caps and statistical care coverage--massive exchanges of information will allow incentive structures to encourage physicans to provide the best care at a fixed total cost


Table of Contents

Copyright 2000 by David Black-Schaffer