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PubMed1983

Weighing the views of a university hospital and medical school regarding an HMO.

After 14 years of study, the University of Michigan decided to terminate development of a health maintenance organization (HMO). The process was long and difficult because of the university's need to consider the HMO from the university's perspective of both an employer and a provider. As an employer, the university's early view was favorable and then declined when employee interest was found to be weak and the HMO's impact on the rapidly rising cost of the university's health insurance benefit was determined to be modest. As a provider, the university's view was mixed. In regard to its hospitals, the university's judgment was positive largely because it hoped that HMO incentives might help the hospitals remain viable in the health care delivery environment that was becoming increasingly competitive. From the Medical School's point of view, an HMO was felt not to be desirable because it could put in jeopardy the professional fee revenue used by the school to help underwrite its academic programs, which are the primary source of faculty pride and recognition.

Health Benefit Plans, Employee↗
PubMedDate not supplied

Creating consensus on coverage choices.

The framework for reaching near-universal coverage outlined in this paper combines tax credits for private insurance and public program expansions. It illustrates how a series of incremental steps could be phased in to achieve near-universal coverage. Hallmarks include creation of a Congressional Health Plan; use of the income tax system to provide tax credits and enroll uninsured people; creation of a state Family Health Insurance Program open to everyone below 150 percent of poverty; and creation of a Medicare Part E, open to the disabled and uninsured older adults. The paper provides coverage and cost estimates and identifies potential sources of revenue to finance coverage.

Financing, Government↗
PubMed1997

The logic of tax-based financing for health care.

Employment-based health insurance faces serious problems. For the first time, the number of Americans covered by such health insurance is falling. Employers strongly oppose the employer mandate approach to extending health insurance. Employment-based financing is regressive and complex. Serious debate is needed on an alternative solution to financing health care for all Americans. Taxation represents a clear alternative to employment-based health care financing. The major criterion for choosing a tax is equity, with simplicity a second criterion. An earmarked, progressive individual income tax is a fair and potentially simple tax with which to finance health care. The political feasibility of such a tax is greater than that of employer mandate legislation.

Health Benefit Plans, Employee↗
PubMed2003

Equity in access to child health insurance in the United States.

In an article that appeared in the New York Times on September 10, 2000, David E. Rosenbaum explicated the paradox that continues to define US medicine.(1) "In an era of unrivalled prosperity, Americans express confidence in their ability to handle most, if not all, economic concerns." He goes on to say, "The authorities and the public have begun to doubt whether costs for medical care can ever be contained, or that a practical way exists to provide insurance for all citizens. The only economic indicator that worsened in recent years is the number of Americans without health insurance. In the United States, we can make a case that what is economically rational is politically unacceptable." As the US and global economy vacillates in and out of recession, the opportunity to alter the course of US politics to effect significant change in access to health care for all Americans seems to be sliding further and further from our grasp.

Child↗
PubMed2003

Universal health care: lessons from the British experience.

Britain's National Health Service (NHS) was established in the wake of World War II amid a broad consensus that health care should be made available to all. Yet the British only barely succeeded in overcoming professional opposition to form the NHS out of the prewar mixture of limited national insurance, various voluntary insurance schemes, charity care, and public health services. Success stemmed from extraordinary leadership, a parliamentary system of government that gives the winning party great control, and a willingness to make major concessions to key stakeholders. As one of the basic models emulated worldwide, the NHS-in both its original form and its current restructuring-offers a number of relevant lessons for health reform in the United States.

Efficiency, Organizational↗
PubMed2006

Codes and colleagues: Is there support for universal patient acceptance?

This article is a refinement of verbal reactions to O'Toole's and Corsino's remarks at a national conference on Access to Oral Health Care held at the headquarters of the American Dental Association in August 2005. The article consists of two parts, each part an answer to specific questions. The first is a reaction to Corsino's explanation of Patthoff's concept of Universal Patient Acceptance. Acceptance is supported and endorsed, and a case is made for the importance of a clear and accurate explanation of Universal Patient Acceptance, as it has a much greater likelihood of being embraced by dentists than "access" seems to have. A review of relevant codes of ethics in dentistry reveals mixed and uneven support for Universal Patient Acceptance. The second part of this article compares the way that the profession of psychology views access and acceptance with the way that dentistry seems to view them and concludes that, if dentistry is to remain a caring profession rather than a commercial enterprise, acceptance must be embraced.

American Dental Association↗
PubMed2004

Knowledge-based changes to health systems: the Thai experience in policy development.

Over the past two decades the government in Thailand has adopted an incremental approach to extending health-care coverage to the population. It first offered coverage to government employees and their dependents, and then introduced a scheme under which low-income people were exempt from charges for health care. This scheme was later extended to include elderly people, children younger than 12 years of age and disabled people. A voluntary public insurance scheme was implemented to cover those who could afford to pay for their own care. Private sector employees were covered by the Social Health Insurance scheme, which was implemented in 1991. Despite these efforts, 30% of the population remained uninsured in 2001. In October of that year, the new government decided to embark on a programme to provide universal health-care coverage. This paper describes how research into health systems and health policy contributed to the move towards universal coverage. Data on health systems financing and functioning had been gathered before and after the founding of the Health Systems Research Institute in early 1990. In 1991, a contract capitation model had been used to launch the Social Health Insurance scheme. The advantages of using a capitation model are that it contains costs and provides an acceptable quality of service as opposed to the cost escalation and inefficiency that occur under fee-for-service reimbursement models, such as the one used to provide medical benefits to civil servants. An analysis of the implementation of universal coverage found that politics moved universal coverage onto the policy agenda during the general election campaign in January 2001. The capacity for research on health systems and policy to generate evidence guided the development of the policy and the design of the system at a later stage. Because the reformists who sought to bring about universal coverage (who were mostly civil servants in the Ministry of Public Health and members of nongovernmental organizations) were able to bridge the gap between researchers and politicians, an evidence-based political decision was made. Additionally, the media played a part in shaping the societal consensus on universal coverage.

Cost Control↗