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TABLE 2-1 Health Plan Choices for Private Sector Employees, 1993
Number of Health Plans Offered per Establishment
Weighted by Number of Establishments (%)
Weighted by Number of Employees (%)
5 or more
SOURCE: Preliminary tabulations from the 1993 Robert Wood Johnson Foundation Employer Health Insurance Survey conducted by the RAND Corporation (courtesy of Stephen Long).
kets. In this new system, government attempts to structure the market by encouraging competition, consumers have an array of health care options to choose from, and health plans share responsibility for accountability with the government. This accountability is reinforced by the power of the consumer to choose and to change plans. In the Medicare-restructuring proposals developed by the 104th Congress and the Clinton Administration, elderly beneficiaries would have choices beyond the current fee-for-service, traditional Medigap, and risk-based HMO options. These choices will include preferred provider organizations (PPOs), unrestricted fee-for-service health plans, and high deductible plans combined with medical savings accounts. Under the new paradigm most Medicare beneficiaries would have more health plan choices than the majority of today's private sector employees (Table 2-1).
To ensure accountability and informed purchasing for beneficiaries in a restructured Medicare program, a continuum of structural and oversight options can be considered. These range from (1) a more active government role, to (2) strengthening the role of the consumers so that they are better equipped to exercise choice, to (3) strengthening professional influences and advancing the science base for clinical effectiveness and outcomes. Each of these directions involves trade-offs.