Alternative Health Care Delivery Systems For US

 
 
 
 
ALTERNATIVE HEALTH CARE DELIVERY SYSTEMS

Three alternative health care delivery systems that could be implemented in the United States by the year 2000 have gained substantial support. The first of these alternative health care delivery systems is a managed care program. A second alternative health care delivery system envisions the creation of a Canadian-style system in which funding is provided by government, fee schedules are negotiated by government and providers, and medical consumers have freedom of choice in the selection of care providers. A third alternative health care delivery system is the Health Insurance of America plan under which all employers desiring to provide health care insurance for their employees would be guaranteed that coverage would be available to all employees irrespective of individual health problems existing within an employer group. These three potential health care delivery systems are described and assessed.

Managed care is a program type that proponents claim ensures appropriate care for a wide range of medical treatments through the application of techniques such as pre-admission certification, concurrent review, case management, utilization rules, and price limits (Gales, 1996, pp. 48-56). Opponents contend that managed care is a deceitful sham designed to maximize profits and minimize care (Merwin & Fox, 1992, pp. 139-149). The truth about managed care likely lies at some point along this contin


     
 
 
 
    

 

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hysician of their choice. Poor Americans, by contrast, are not. Health care expenditures account for approximately 10 percent of the gross national product in the United States (Evans, 1994, pp. 21-42). Further, the rate of price inflation for health care costs is higher than that for all items. During the next decade, health care costs are expected to consume an increasingly larger proportion of the country's gross national product. In Canada, health care costs also are rising. Even with universal health care, and with health care quality generally equal to that in the United States, however, health care costs in Canada consume less than seven-percent of that country's gross national product. Approximately 60 percent of the American population is covered by private health care insurance programs. Most of these programs the very great majority are either fully or partly funded by employers, while the remainder are funded fully by the covered individuals and families. Through the Medicaid Program and other programs, the federal government funds the delivery of health care services for an additional 25 percent (approximately) of the population. When all is said and done, approximately 15 percent of people in the country

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