Changing the Health Care System Models from Here and Abroad (1994) / Chapter Skim
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Operating Under a Global Budget: Perspectives from the United States and Abroad
Operating Under a Global Budget: Perspectives from the United States and Abroad
Pages 68-75
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From page 68... ...
EXPENDITURE- VERSUS BUDGET-DRIVEN HEALTH SYSTEMS Under expenditure-driver financing, the providers of health care were allowed to do for patients whatever they saw fit and to send the rest of society a bill at prices that seemed "unreasonable." Typically, those presented with the bill paid without reservations or, if they had reservations they paid the bill nevertheless because they lacked the countervailing power present in normal markets without a third-party payment system. Naturally, under this open-ended approach the supply side of the health sector became a rich economic frontier that attracted both the genius of private entrepreneurship and its relentless search for mammon.
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From page 69... ...
For the most part, both the government and private-sector payers in the United States are able to figure out what they have spent on health care in any given year only with a lag of a year or so. In fact, the announcement of total national health spending in recent years has lagged actual spending by close to 2 years.
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From page 70... ...
But while there is now a rising chorus for budget-driven health care delivery in the United States, such a policy is not easily implemented, because the country still lacks the institutional framework through which global budgets or global expenditure targets would be established at the national level and apportioned to regions and individual institutions. Therefore, a good part of the coming year is likely to be spent (1)
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From page 71... ...
People accustomed to defending our expenditure-driven financing of health care with appeals to the threat of rationing are likely to discover, in the course of the looming debate on health policy, that this argument will lose its power. The word rationing per se is not likely to frighten those in the private and public sectors who yearn for firm, prospective health care budgets.
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From page 72... ...
By contrast, the American proponents of managed competition believe and the proper word is believe that, by paying for everything that is beneficial, but denying payment for everything else, the nation can avoid setting arbitrary global budgets and will, in the end, devote the "right" percentage of the GNP to health care. These proponents have considerable faith in the ability of ordinary consumers to choose wisely among the alternative cost-quality combinations offered to them by competing managed care systems in the health care market.
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From page 73... ...
This question confronts the proponents of the concept with an equally vexing moral dilemma that they ought not to overlook: Can they, in good conscience, persuade the President to take that gamble, to eschew global budgets, at the risk of entering the presidential campaign in 1996 with a visibly broken promise expressly made during the campaign of 1992, namely, that he would bring health care costs under control? In this respect, he clearly has much more to lose than the policy analysts who are marketing the theory.
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From page 74... ...
Or should we settle on an alternative definition of "equitable"? For example, we could define the phrase "equitable access to needed health care" in at least three distinct ways, as follows: 1.
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From page 75... ...
On the other hand, of course, the approach raises issues of fairness among contemporaries. In effect, it might link the probability of surviving a given medical condition to a person's socioeconomic status.
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