Health care reform

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(This article is about political movements affecting the delivery of health care and health care systems. For more information about movements to improve health, see Health reform.)

Health care reform is a general rubric used for discussing major policy creation or changes --for the most part, governmental policy --that affects healthcare delivery in a given place. Health care reform typically attempts to:

Broaden the population covered by private or public health insurance
Expand the array of health care providers consumers may choose among
Improve the access to health care specialists
Improve the quality of health care
Decrease the cost of health care
Decrease the cost of health insurance

1 Global Overview
2 Health Care Reform in the United States
3 See also
4 References
5 External links

[edit] Global Overview

In the United Kingdom a massive programme of attempted reform of the British National Health Service had begun as of 2007. In the United States, health care reform was a major concern of the Bill Clinton administration headed up by First Lady Hillary Clinton; however, the Clinton health care plan was not enacted into law. More recently, President George W. Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act which included a prescription drug plan for elderly and disabled Americans.^[1] U.S. efforts to achieve universal coverage began with Theodore Roosevelt and continue to today.

As evidenced by the large variety of different health care systems seen across the world, there are several different pathways that a country could take when thinking about reform. Germany for instance, makes use of sickness funds, which citizens are obliged to join but are able to opt out (Belien 87). The Netherlands uses a similar system but the financial threshold for opting out is lower (Belien 89). The Swiss, on the other hand use more of a privately based health insurance system where citizens are risk-rated by age and sex, among other factors (Belien 90). The United States government provides health care to just over 25% of its citizens through various agencies, but otherwise does not employ a system. The free market provides the balance of health care services, generally centered around modestly regulated private insurance methods.

[edit] Health Care Reform in the United States

The United States is in a unique position with regard to health care, being the clear world leader in medical innovation, while at the same time leaving the free market to deliver most health services. For example, researchers in the US earn The Nobel Prize in medicine approximately twice as often as researchers in the rest of the world combined, and research dollars dwarf those of any other nation, including the EU. As a result, the medicines and medical technology developed in the US not only benefit US citizens, but spread broadly into health care systems of other nations, relieving the rest of the world a substantial burden in research.

When the health care expenditures per capita and GDP per capita for developed countries are graphed, a nearly linear relationship is revealed, with the United States the clear outlier.^[2]

Reforming or restructuring the private health insurance market is often suggested as a means for achieving health care reform in the U.S. Insurance market reform has the potential to increase the number of Americans with insurance, but is unlikely to significantly reduce the rate of growth in health care spending. If not implemented on a systematic basis with appropriate safeguards, market reform has the potential to cause more problems than it solves. ^[3] Since most Americans with private coverage receive it through employer-sponsored plans, many have suggested employer "pay or play" requirements as a way to increase coverage levels. However, research suggests that current pay or play proposals are limited in their ability to increase coverage among the working poor. These proposals generally exclude small firms, do not distinguish between individuals who have access to other forms of coverage and those who do not, and increase the overall compensation costs to emplooyers.^[4]

Premium subsidies to help individuals purchase their own health insurance have also been suggested as a way to increase coverage rates. Research confirms that consumers in the individual health insurance market are sensitive to price. Estimates of the demand elasticity in this market vary, but generally fall in the range of -0.3 to -0.1. It appears that price sensitivity varies among population subgroups, and is generally higher for younger individuals and lower income individuals. However, research also suggests that subsidies alone are unlikely to solve the uninsured problem in the U.S. ^[5]^[6]

A report published by the Commonwealth Fund in December of 2007 examined 15 federal policy options and concluded that, taken together, they had the potential to reduce future increases in health care spending by $1.5 trillion over the next 10 years. These options included increased use of health information technology, research and incentives to improve medical decision making, reduced tobacco use and obesity, reforming the payment of providers to encourage efficiency, limiting the tax federal exemption for health insurance premiums, and reforming several market changes such as resetting the benchmark rates for Medicare Advantage plans and allowing the Department of Health and Human Services to negotiate drug prices. The authors based their modeling on the effect of combining these changes with the implementation of universal coverage. The authors conclude that there are no magic bullets for controlling health care costs, and that a multifaceted approach will be needed to achieve meaningful progress.^[7]

A fundamental problem in evaluating reform proposals is the difficulting estimating their cost and potential impact. Because proposals often differ in many important details, it is difficult to provide meaningful side-by-side cost comparisons. The empirical data and theory underlying cost estimates in this area are limited and subject to debate, increasing the variation between estimates and limiting their accuracy.^[8]