A Medicare reform primer

The use of the federal budget process to change Medicare policy is of importance to physician executives because of its impact on the health care delivery system. In particular, changes in Medicare policy, driven by the need to shore up the solvency of a politically popular program, will create changes for other public and private purchasers of health care. Reforming Medicare through the budget process is not new. Physician fees have been frozen, reduced, and selectively increased as a result. In 1983, the hospital reimbursement methodology was changed to prospective payment through this process. The budget process will continue to be used to make policy changes because of the large amount that Medicare occupies of the federal budget. Given the profound impact changes in Medicare can have in other health care sectors, the lack of consensus for a long-term solution would mean those in the health care arena will have to be prepared for significant annual policy changes through the reconciliation process.     

Are health providers still patients' chief advocates?

The pressures of competition and the health care marketplace have changed the relationship between health care providers and patients. Patients, and the third-party payers who control health care dollars, are less in awe of providers' prerogatives, and providers have become timid in asserting their rights and their knowledge in the health care equation. Providers can regain their role as patients' advocates, however, if they acknowledge the realities of the marketplace but are open in their dealings with patients.     

A proposal for health care reform

A radical overhaul of the health care system is proposed by one doctor who's fed up with the current system. His ideas include competing systems sponsored by the government and the private sector.     

Super doc and real health reform

A large array of social, economic, and professional issues will have to be confronted and resolved before primary care physicians can take their logical place as leaders in the health care delivery system. Linkages will have to be forged between primary care physicians and specialists and between primary care physicians and nonphysician providers of primary care. Key to successful resolution of the current dilemma is ensuring that primary care physicians are compensated at a fair level for their skills. It is the disparity in physician incomes that lies at the heart of the problem, according to the author.     

System reform in integrated health systems

As the debate progresses on health care reform and the ultimate form of the U.S. system, important lessons can be drawn from examinations of other health care systems. From the U.S. perspective, European health systems appear to have a certain homogeneity about them. Americans tend to look at all European arrangements as single-source financing systems. Because these systems all provide universal coverage, the assumption is that there must be a strong cohesion and similarity among them. Viewed from the European perspective, the reality appears to be rather different. In this article, the health cae systems of Nordic countries are analyzed in terms of their differences both from other European systems and from the United States approach.     

医改路何方,领导一句话

最近,去了安徽省的马鞍山市和芜湖市考察公立医院改革的情况,可以说,受益匪浅。凑巧,媒体也报道了北大李玲教授对芜湖整体医疗改革的看法。     

Fiscal health of hospitals in a decade of Medicare

The accompanying article is testimony that was presented by Dr. Long before the Subcommittee on Health of the Committee on Ways and Means of the U.S. House of Representatives on February 27, 1991. The testimony was presented in conjunction with the subcommittee's hearing on Hospital Payment under Medicare in conjunction with receiving ProPAC's Seventh Annual Report to Congress.     

Computer-based patient records: a building block for health care reform

The fundamental need for better information management capabilities in health care is at risk of being overlooked in the proposals for major national changes aimed at providing health security, controlling costs, enhancing quality, and expanding access for citizens. In addition to these proposed macro changes (e.g., universal access, guaranteed benefit package, national health board, regional health alliances), successful reform will require transformation of health care delivery at the micro level. We must overcome provider-dependent variations in clinical practice patterns, in quality of performance, and in costs of services. We must ensure movement toward appropriate care rather than simple rationing. Individual health care professionals and institutions must acquire and use tools that will enable them to provide their services cost-effectively with consistent results. We must be able to assess and ensure value--i.e., appropriateness, effectiveness, and cost--of health services, apply that knowledge in each and every patient encounter, and track the impact of clinical decisions through an analysis of aggregated databases.     

The ethics of health care system reform

The United States is now engaged in a momentous national debate about health care. How can we provide the best care possible while simultaneously containing cost (to promote the general economic integrity of society) and somehow maintain a semblance of a free health care marketplace. This is not just a political question; it is also a question of ethics. It is an ethical consideration because the current debate is not just about designing or promoting health care systems that can best address our concerns for costs, quality, and accessibility. It appears that at least some participants in the debate would not stop at arguing their beliefs as valid; they would make their beliefs law. Some urge the creation of the right to health care as a matter of law. There are significant differences between beliefs and rights, however, and they need to be considered carefully in the ongoing debate over the future of this country's health care delivery and financing system.     

In search morally intelligent health care reform

The health care policy debate is bitterly divisive because so much money is involved. Politicians want to keep the passionate debate going instead of acting. Why commit political suicide by opposing insurance and drug companies instead of prospering by hooking up with them?     

A guide to the upcoming health reform debate

AT the 1992 ACPE National Institute, several hundred physician executives actively participated in a debate on three competing visions for the health care system in the United States. This new column in the journal attempts to further this process by providing information on policy positions of relevance to College members. While the College does not advocate a particular position, the College encourages individual members to contact the interest group of their choice and get involved in the health policy debate. In this first column, one of the proposals currently being discussed is summarized.     

Quality improvement in the era of health reform

More and more scrutiny is certain for the health care field. The intense interest in medical quality management that has been a factor in the field for many years is certain to increase under any reform that the system undergoes. This is a unique opportunity for physician executives to play a leading role in the future course of health care delivery. The alternative of their involvement will be almost total control of the issue by regulators.     

Health care reform. Four variables and a theory: an equation for health care

Writings about health care reform currently appearing in all manner of publications often can confuse, rather than clarify, both problems and solutions. One of the strengths of the study of economics is the ability to summarize complex situations in graphic form, and one of the benefits of management theory is to visualize approaches to problems in a broad and well-organized manner. Three recent articles, when combined, suggest a fresh analysis of the problems demanding health care reform in this nation. They are reviewed here and synthesized into a philosophical view that encourages a more positive approach to solutions for the problems. The first article considers an economic theory with striking applications to health care. The second article suggests one management approach for the future for both for-profit and not-for-profit organizations. The third article takes a fresh approach to competition in health care. This review will discuss the economic theory and then apply the management principles to the problem of health care reform confronting the profession and the nation today.     

Medicare and Medicaid: the first successful effort to increase access to health care

The passage of Lyndon Johnson's health care legacy, Medicare and Medicaid, in 1965 represents the last time that health reform legislation expanding access to care was successfully proposed and implemented in the United States. Access, of course, represents only half the pie in health reform, the other part being the organization of the health care system. There has never been any major legislation passed through both houses of Congress and signed by a President that changed the organization and delivery of health services. It seems certain that President Clinton will propose legislation dealing with both access to and organization of our health care system. Though it may not have seemed so at the time, President Johnson had it easy compared to the challenges confronting President Clinton.     

The impact of health care reform on group practice

Just two years ago, it would have been very difficult to imagine that reform of the health care system would today be a national domestic priority and that Congress would be considering one of the most significant and far-reaching pieces of legislation in the past 50 years. The issue is still in doubt, but it seems clear that, in this session of Congress or the next, legislation of far-reaching consequences will likely be passed. In fact, change on a widespread scale has already begun. During 1993, every state legislature except those of Nevada and Wyoming considered measures that would alter the way medical care is financed and delivered. Of the states that acted, both last year and in recent legislative sessions, eight have passed laws with the ultimate objective of ensuring access to medical care for all citizens. Government, at both the state and federal level, is clearly taking on the health care issue. The impact of reform on physicians, and thus on group practices, will be substantial. This article outlines the current course of health care reform and addresses its specific implications for the management of group practices.     

Primary care: the driver in health care reform

The changes occurring in the health care industry have resulted in a cost-quality competition that has not been present in the past. Because of this competition, managed care is a growing way of financing and providing health care to the people of the United States. Managed care depends heavily on competent primary care physicians. Because primary care physicians are in short supply, the status and financial rewards of primary care practice are increasing. The primary care physician will be the dominant force in medical practice in the immediate future. He or she is capable in a managed setting of resolving the perceived problems of the health care industry in responding to the drivers of health care reform. Costs are reduced while quality is maintained. Access to health care is improved, and fragmentation of health care is significantly lessened.     

Implementing workforce development in health care: A conceptual framework to guide and evaluate health service reform

Abstract

The term ‘workforce development’ is increasingly popular in the health-care field. It appears to encompass a range of human and organizational development activity. However, there has been limited explication of the concept of workforce development in Australian health care at area health service levels. It is timely to develop a framework for workforce development and processes to guide any evaluation of the implementation of workforce development strategies. This paper presents a framework that has been developed through consultative processes in an area health service and an associated review of literature.     

The paradoxes of national health reform during the Wilson era

The current debate over health care reform may represent yet another opportunity to establish a national health policy. A similar level of activity occurred during the presidency of Woodrow Wilson. In many ways, the failure to enact national health reform (NHR) in the early 20th Century represents a paradigm for subsequent failed attempts to enact NHR.