National Health Care Reform NATIONAL HEAL

Waitzkin (1994, pp. 482-494) draws a parallel between the planning-programming-budget system (PPBS) concept applied by public sector organizations and the concept of managed competition (often referred to as managed care) that has been proposed as a basis for national health care reform. Waitzkin (1994, pp. 482-494) describes the application of the PPBS concept to the military health care system in the 1960s as a form of managed care. The application of the PPBS concept to the delivery of military was a failed experiment. Waitzkin (1994, pp. 482-494) argues that, while the experience of the military health care system with PPBS raises warning flags for those who would make managed care the basis for national health care reform, the earlier experience does not ensure that managed care would be a failure as a basis for national health care reform.

Waitzkin (1994, pp. 488) concludes that managed competition, or managed care, as a basis for national health care reform may lead American health care "down a path inconsistent with the aspirations of many health workers and patients." Such a development also likely would lead to a failure of the concept of managed competition. This researcher supports these conclusions related to managed care.

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 preadm

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tutions in both the public and private sectors. Budget reductions and increased attention to the efficiency and effectiveness of governmentally-provided services of all types are added pressures for health care institutions receiving public funding. The development of effective approaches to the solution of the problems associated with this issue, however, is a difficult task. Improving the efficiency of the nation's health care system is an objective with which few health care professionals have a quarrel. Many health care professionals, however, do tend to reject initiatives that appear to be further manifestations of codified bureaucratic machinations that likely will have no long-lasting positive impacts on the quality of health care services. The managed care concept injects free market economics and entrepreneurship into the health care environment. Critics of the concept of managed competition contend that an application of the concept as a basis for national health care reform will result in a shifting in emphasis from patient care to earning a profit. A top management representative at Humana, a leading managed care organization, said that: "If you cannot make an argument in numbers, you cannot work here. W

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