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PubMed2002

Alberta's provincial Travelling Clinic, 1924-42.

Providing health services to sparsely populated, geographically isolated areas was a major challenge in many Canadian provinces before the advent of universal hospital insurance in the late 1950s, and universal physician insurance in the late 1960s. The task was especially daunting during the interwar depression years. Nonetheless, from 1924 to 1942, Alberta's Department of Public Health sponsored an itinerant Travelling Clinic during the summer which conducted physical examinations, dental examinations and treatment, tonsillectomies and other minor surgery, and vaccination against smallpox to children in frontier areas of the province. This article analyses Alberta's Travelling Clinic from a public policy perspective and concludes that through the Travelling Clinic, the Alberta government provided a health service valued by many settlers at nominal cost to itself.

Ambulatory Care Facilities↗
PubMed1991

Utilization management as a cost-containment strategy.

Utilization management (UM) is now an integral part of most public and private health plans. Hospital review, until recently the primary focus of UM, is associated with a reduction in bed days and rate of hospital cost increases. These reductions appear to have had limited impact on aggregate health care costs because of increases in unmanaged services. In the future, with electronic connectivity between payers and providers and the use of clinical guidelines and computer-based decision-support systems, the need for prospective case-level reviews will be reduced. With these changes, UM programs are likely to become more acceptable to providers and patients.

Cost Control↗
PubMed1993

Health economics in the United States: cost implications.

World health care costs are increasing uncontrollably and will continue to grow even if draconian controls are implemented immediately. In the United States, the health care objectives are to control the escalating costs of health care and increase access to quality care. To achieve these goals, new administrative controls will be put in place to respond to the cost pressures. New policies to accommodate these new controls will be made by the state and federal governments and by various private third parties. The policies will contain incentives and disincentives for private and institutional providers and beneficiaries. As a result, providers are responding with various cost-control techniques and payors are attempting to reduce costs. In addition, new decision makers in hospitals, insurance companies, and government will be evaluating new technologies by new standards. In order to gain or maintain significant market penetration for a product, drug and device manufacturers will have to develop a multifaceted strategy to present their products in the most favorable economic light.

Cost Control↗
PubMed1994

The future financing of Medicare.

Regardless of the timing and the type of federal action to reform the nation's health care system, the Medicare program's financial problems must be addressed soon. Serious concerns exist about both the Hospital Insurance and the Supplementary Medical Insurance portions of the program.

Health Care Costs↗
PubMed1996

Joining a capitated IPA: should you, or shouldn't you?

The "bygone" doctor practiced in the good old days under a relatively uncomplicated, clearly defined system. Physicians could afford to be independent. To survive in practice today, say the authors of "Renegotiating Health Care: Resolving Conflict to Build Collaboration," physicians must adapt to change or the health-care market will pass them by. Today's "evolving" doctor is a partner, contributing to and deriving benefit through collaborative patient-care networks, physician practice organizations, and medical services organizations. Historical rivalries have been forgotten as hospitals, insurers, and physicians seek and achieve innovative alliances. Still, resistance to these plans runs strong. The following story typifies one dilemma that faces physicians today. It concerns a hypothetical group practice that must decide whether to form a capitated individual practice association.

Capitation Fee↗
PubMed1993

Utilization and costs of substance abuse services within The HMO Group.

This paper describes the organizational characteristics, benefit coverage, referral pathways, utilization rates, and costs of substance abuse services within 17 HMOs belonging to The HMO Group in 1990. All 17 health plans responded to the questionnaire. Responses to the survey reflected the complexity of HMO substance abuse services. Overall, The HMO Group members provided substance abuse service coverage partly dependent upon state mandates, employer group priorities, and local competitive benefit structures. The HMOs reported that service utilization rates and the productivity of their substance abuse providers were critical information needs currently not fully reported. Overall, the survey responses reflected the need for improvement of clinical information systems and expansion of the aggregate substance abuse database.

Health Care Coalitions↗
PubMed1995

Strategic implications of a "paperless" information system.

The movement of the typical medical practice toward increased size, dispersed operations and formalized affiliations with hospitals, insurance companies and other providers has exacerbated the problems of information management. Antiquated information systems have become a serious impediment to efficient operations in many medical practices. This professional paper describes the advantages, obstacles and necessity of implementing a comprehensive electronic information system.

Electronic Data Processing↗
PubMed1999

Canada's health system.

AIM: To examine the Canadian health system, in particular as it relates to health care, and to assess the functions of the provincial and federal governments in relation to health care, spending, funding, and reform. METHODS: Description and analysis of the Canadian health care system, including the overall structure, funding and spending, history, necessary reforms, and future of the system. RESULTS: Canada's health care system, through funding from both the federal and provincial/territorial governments, provides insured hospital and medical care services to all eligible Canadian residents. In order for the provinces to receive funding from the federal government, five criteria as stated in the Canada Health Act, must be met, namely: public administration, comprehensiveness, universality, accessibility, and portability. Funding is provided primarily through taxation, with some provinces also utilizing ancillary funding methods, such as health care premiums. In the latest review of Canada's health care system, the National Forum on Health reported in 1997 that the system must become more efficient, effective, and reflective of contemporary practices in health care delivery. CONCLUSIONS: The benefits of our system can be seen in the favorable health status of Canadians. Canada has been successful in its efforts to contain health expenditures and begin the process of reallocating resources. Health care is recognized as only one element of a larger health system, encompassing a broader range of services, providers, and delivery sites.

Canada↗