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PubMed1991

Surgeons and HIV.

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Ethics, Medical↗
PubMed1991

Health insurance values and implementation in The Netherlands and the Federal Republic of Germany. An alternative path to universal coverage.

The health care systems in the Netherlands and the Federal Republic of Germany are based on a set of values that involve mutual obligations between private parties. These obligations are realized through systems incorporating private practice physicians, community and church- and municipality-affiliated hospitals, and nonprofit and for-profit insurers. The underlying values and implementation approaches in these systems provide an alternative to the adoption of a Canadian-style health insurance system. A discussion that focuses on "obligations" rather than "rights" may be a more useful approach for the design of reforms of the American health system in the 1990s. Such a discussion would focus on the mutual responsibility of all parties to create and maintain a universal private health care system.

Germany, West↗
PubMed1991

Expanding Medicare and employer plans to achieve universal health insurance.

This article presents a proposal for expanding Medicare and employer-based health insurance plans to achieve universal health insurance. Under this proposed health care financing system, employees would provide basic health insurance coverage to workers and dependents, or pay a payroll tax contribution toward the cost of their coverage under Medicare. States would have the option of buying all Medicaid beneficiaries and other poor individuals into Medicare by paying the Medicare premiums and cost sharing. Other uninsured individuals would be automatically covered by Medicare. Employer plans would incorporate Medicare's provider payment methods. This proposal would result in incremental federal governmental outlays on the order of $25 billion annually. These new federal budgetary costs would be met through a combination of premiums, employer payroll tax, income tax, and general tax revenues. The principal advantage of this plan is that it draws on the strengths of the current system while simplifying the benefit and provider payment structure and instituting innovations to promote efficiency.

Costs and Cost Analysis↗
PubMed1991

Universal health insurance through incentives reform.

Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.

Aged↗
PubMed1991

A tax reform strategy to deal with the uninsured.

The high level of ininsurance in the United States is due in large measure to the tax treatment of health care, which is based on the tax exclusion for company-provided plans. Correcting the perverse incentives for providers and patients resulting from this tax treatment is the crucial step to creating a national health care system that is affordable and efficient. The Heritage Foundation proposal calls for the elimination of the current tax exclusion and its replacement with a system of refundable tax credits for the purchase of health insurance and medical services.

Federal Government↗
PubMed1990

Legal and ethical issues relating to AIDS.

The worldwide AIDS epidemic has posed an extraordinary array of ethical and legal challenges. The work presented here reviews three issues at the heart of the matter: discrimination against HIV-infected people, the limits of confidentiality, and the exercise of coercive government powers to limit spread of the disease. Because the authors are most familiar with the U.S. experience, the review deals primarily with the history of the epidemic in the United States and public responses to it in that country.

Acquired Immunodeficiency Syndrome↗
PubMed1990

HIV-testing of dental students and faculty: benefits, detriment and implications.

Many medical and legal problems have been raised by the acquired immunodeficiency disease. While there is a large volume of literature which addresses these problems, scant attention has been paid to problems which arise when health care faculty and students are affected by this disease. Some health care administrators have discussed the propriety the routine testing of faculty and students for HIV disease, especially when invasive procedures are involved: This article discusses some of the legal issues which attend routine HIV testing in this context. Arguments for and against routine testing are presented. In addition, routine testing is distinguished from targeted testing in response to the reasonable belief that a health care worker is HIV-positive. It is argued that routine testing of health care workers is legally unwarranted. There are arguments, however, that testing of those believed to be HIV-positive is legally sound. Targeted HIV testing may be especially useful and permissible when the worker performs invasive procedures.

AIDS Serodiagnosis↗
PubMed1990

Policy considerations of human immunodeficiency virus (HIV) infection in U.S. Naval aviation personnel.

This article reviews the available medical data that form the basis for the U.S. Navy's policy on aeromedical disposition of Human Immunodeficiency Virus (HIV) seropositive flyers. Following a brief review of military HIV antibody testing and clinical evaluation, this article addresses the main issue in the Navy's aeromedical disposition policy--the subtle neurologic sequelae of HIV infection or HIV encephalopathy. Following a review of the available knowledge of HIV involvement in the nervous system, the aeromedical considerations that form the basis of Navy policy of permanently grounding without waiver all HIV seropositive flyers is discussed.

AIDS Dementia Complex↗