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PubMed1994

Attitudes of Washington State physicians toward health care reform.

Attitudes of Washington State physicians about health care reform and about specific elements of managed competition and single-payer proposals were evaluated. Opinions about President Clinton's reform plan were also assessed. Washington physicians (n = 1,000) were surveyed from October to November 1993, and responses were collected through January 1994; responses were anonymous. The response rate was 80%. Practice characteristics of respondents did not differ from other physicians in the state. Of physicians responding, 80% favored substantial change in the current system, 43% favored managed competition, and 40% preferred a single-payer system. Of physicians responding, 64% thought President Clinton's proposal would not adequately address current problems. Reduced administrative burden, a central element of single-payer plans, was identified by 89% of respondents as likely to improve the current system. Other elements of reform plans enjoyed less support. More procedure-oriented specialists than primary care physicians favored leaving the current system unchanged (28% versus 8%, P < .001). While physicians favor health care reform, there is no consensus on any single plan. It seems unlikely that physicians will be able to speak with a single voice during the current debates on health care reform.

Attitude of Health Personnel↗
PubMed1993

The American states and Canada: a comparative analysis of health care spending.

Most comparisons of the relative effectiveness of cost containment in the Canadian and U.S. health systems trace Canada's greater success to its single-payer approach. However, these studies ignore the substantial variation that exists in hospital and personal health care spending among both the American states and the provinces and territories of Canada. Four American states have adopted all-payer hospital rate setting; one other uses competitive bidding. All five show rates of growth in per capita hospital spending comparable to (and in some cases, lower than) the Canadian jurisdictions. Hospital spending, as a percentage of state gross domestic product (GDP), declined or remained constant in four of the five states. In four out of the five, growth in per capita spending on personal care, as a percentage of GDP, remained or fell below the national average. By contrast, in Canada, per capita spending on both hospitals and personal health care increased as a percentage of GDP in ten out of eleven jurisdictions. In each of the U.S. states, government played a central role in structuring the terms of payment and thus strengthened the hand of purchasers over providers. This strategy, rather than specifically a single-payer or universal health insurance approach, seems to be the key to limiting the growth in health costs to the growth in state or national income.

Canada↗
PubMed1991

The West German health care system: a critique.

Several leading health policy staff of the AFL-CIO and major unions met with the Board of Physicians for a National Health Program (PNHP) in May 1990. They described the active discussions currently ongoing within the AFL-CIO Health Care Committee, which is composed of 14 international union presidents and sets AFL-CIO policy on health care issues. Some union presidents reportedly favored a single-payer, Canadian-style approach, while others apparently preferred a proposal modeled after the West German system, which preserves a major role for insurance companies. The PNHP Board was emphatic in its preference for the single-payer approach. Board member Dr. Vicente Navarro wrote the following letter to the union presidents on the AFL-CIO Health Care Committee detailing his critique of the West German approach.

Canada↗
PubMed1993

Health-care reform. Single-payer models.

Health-care reform is one of the most urgent issues facing the United States today. The current system is marked by enormous disparities between services available to those with virtually unlimited resources and those who must pay for services directly. Among the options being considered is that of a single-collector, state-based system with universal access, effective cost control, administrative simplicity, re-allocation of services toward primary and preventive care, and a reduction in unnecessary services. A key element in such a plan is a politically independent Federal Health Board, which would be responsible for making decisions about the definition of a standard benefit plan to be provided to each American.

Delivery of Health Care↗
PubMed1990

Universal New York Health Care. A single-payer strategy linking cost control and universal access.

Now that universal access to health care is back on the governmental agenda, elected officials are faced with the dilemma of expanding our present pluralistic system of numerous private and public payers, with its built-in administrative inefficiencies and inflationary pressures, or scrapping the present system of financing and moving to a tax-based scheme like the Canadian Medicare program, an option fraught with political difficulties. There is, however, a third option. The New York State Department of Health has developed a proposal for universal access--Universal New York Health Care, or UNY-Care--that would retain the existing payers, including employer-based insurance coverage, but combine them in a one-payer framework. Providers would no longer have to interact with the many public and private payers, each with its own rules, criteria, and levels of payment. The single payer would serve as the only payer for most health care services and would also negotiate reimbursement rates. The single-payer framework should bring savings in administrative and billing costs and should move government closer to the goal of buying health care services--getting good value for payment rendered--rather than simply paying bills as they are submitted. Although the single-payer strategy could be implemented at either the state or the federal level, it seems ideal as the principal responsibility of the states in a national plan for universal coverage.

Cost Control↗
PubMed1994

Health care reform in the 1990s: an analysis of the problems and three proposals.

National health care reform is arguably the most important domestic policy issue of the 1990s and certainly is one of the most difficult and pressing of current social issues. It also is clear that health care reform is as much a political as it is a public policy issue. This article evaluates three health care reform proposals by members of the U.S. Congress--one single-payer model and two "play or pay" models--to analyze how well they responded to the underlying crisis in the American health care system. Specific criteria for evaluating health care reform proposals are delineated, and an evaluation of the competing models is provided.

Delivery of Health Care↗
PubMed1995

A comparison of delays in the treatment of cancer with radiation in Canada and the United States.

PURPOSE: Waiting lists for medical care in Canada have been used as an argument against the single-payer option for health care reform in the United States, but there have been no direct comparisons of access to care in these two health care systems. The objective of this study was to compare how long cancer patients wait for radiotherapy in Canada and the USA. METHODS AND MATERIALS: Heads of radiation oncology at all cancer centers listed by the International Union Against Cancer (UICC) in Canada and the United States were sent a questionnaire that asked how long their patients waited for radiotherapy, and how long they though it was acceptable for patients to wait, in six clinical situations. RESULTS: Ninety-two of 97 eligible centers responded (95%). Median waiting times to start of radiotherapy were as follows: carcinoma of the larynx (T2,N0,M0), 29 days in Canada, 10 days in the USA; carcinoma of the lung (Stage IIIb, squamous), 34 days in Canada, 9 days in the USA; carcinoma of the prostate (Stage B2), 40 days in Canada, 11 days in the USA; carcinoma of the breast (T2,N0,M0) referred 1 month after lumpectomy, 43 days in Canada, 10 days in the USA; carcinoma of the prostate with painful bone metastases, 17 days in Canada, 5 days in the USA; carcinoma of the prostate with spinal cord compression, < 1 day in Canada, < 1 day in the USA. The differences in waiting times between Canada and the USA were all statistically significant (p < 0.0001), except in the case of emergency treatment for cord compression. The majority of radiation oncologists in both Canada and the USA regarded the delays reported by Canadian departments as medically unacceptable. CONCLUSIONS: Patients almost everywhere in Canada wait longer for radiotherapy than they do almost anywhere in the United States.

Aged↗
PubMed1993

Health care reform: clarifying the concepts.

Despite agreement about problems with the health care system, there is disagreement about the remedy. Like most health care reform debates, this article focuses on financing methods rather than service delivery. Reform strategies are intentionally oversimplified into four categories: employer-based or "play or pay"; single-payer and modifications, such as expanding Medicaid or Medicare; market competition; and managed competition, which appears to be favored by the Clinton administration. Cost-control mechanisms and insurance reforms are applicable to all four financing methods. Reform is inevitable. The challenge for nurses is to understand reform issues and then influence policymakers to initiate reforms that make essential medical and preventive services universally available.

Competitive Medical Plans↗