Vermont's Catamount Health: a roadmap for health care reform?

Vermont's new health reform program was enacted under a Republican governor in a state with a Democrat-controlled legislature. It thus serves as an intriguing approach to resolving political differences in health care. James Maxwell's interview of Vermont governor Jim Douglas provides background and insight on these reforms. I build on the interview, focusing on what changed between the 2005 reform failure and the passage of the new reforms. Key to the reform's political success was the recognition by both sides that it focused on issues of bipartisan concern: cost control through the effective management and prevention of disease.     

Health care reform: why? What? When?

Dissatisfaction with the U.S. health care system is widespread, but no consensus has emerged as to how to reform it. The principal methods of finance-employer-based insurance, means-tested insurance, and Medicare-are deeply and irreparably flawed. Policymakers confront two fundamental questions: Should reform be incremental or comprehensive? And should priority be given to reforming the financing system or to improving organization and delivery? We consider here several proposals for incremental reform and three for comprehensive reform: individual mandates with subsidies, single payer, and universal vouchers. Over the long term, reform is likely to come in response to a major war, depression, or large-scale civil unrest.     

Health care reform in South Korea: success or failure?

South Korea is one of the world's most rapidly industrializing countries. Along with industrialization has come universal health insurance. Within the span of 12 years, South Korea went from private voluntary health insurance to government-mandated universal coverage. Since 1997, with the intervention of the International Monetary Fund, Korean national health insurance (NHI) has experienced deficits and disruption. However, there are lessons to be drawn for the United States from the Korean NHI experience.     

National health care reform and a single-payer system: messiah or pariah?

U.S. health care spending consumed about 14% of the GDP in 1992 and current trends threaten to boost this figure to 18% by the year 2000 (CBO, 1992). Our health care delivery system needs an overhaul but there is evidently little consensus on what format a new system should follow. Persuasive befuddling, and frequently contradictory, suggestions have ranged from the federal government's active involvement in a single-payer national health care plan to enactment of a nationwide mandate compelling (taxing?) employers to provide a minimum health benefit package to all workers. There were two common objectives shared by the major, recently contending health care reform proposals: first, to provide universal access to health care with assurances that coverage is maintained when economic circumstances change or when someone experiences poor health; second, to stunt the growth rate of health care spending nationally. Single-payer alternatives, previously introduced by Congressman McDermott and others, would have required a heavy federal subsidy, regulation, and blocking directing each state to establish and administer a health care system covering its entire population. Currently, the single-payer system has become a fading contender in a dissolving list of health care reform options that previously included a new, widely publicized option embracing managed care and so-called "managed competition." Most recently, however, the single-payer proposals have apparently gone nowhere, seriously sustaining sound political defeat. Divergent views of proponents and detractors of a single-payer plan, its funding and operation, are presented. It has become extremely difficult to get Congress to advance any particular proposal because of dire, unsubstantiated socioeconomic impact hypothesizing and the unrestrained politicizing of the health policy formulation process. On February 10th, 1994, the prestigious American College of Surgeons literally stunned the national health care community by its surprise public declaration of conceptual support for the still highly controversial legislative health care reform long-shot, the Single Payer Health Plan (Mcllarth, 1994). As individual physicians weighed the contentious single-payer health care issue against alternatives (O'Heany and Berry, 1994), many health care provider groups even now remain adamantly opposed to a single-payer system (Mitka, 1994), not unexpectedly including the vocally conservative leadership of the American Medical Association (Culhane, 1994; Cotton, 1994). As spokesman for the American College of Surgeons (ACS). Chairman David Murray MD, indicated that the 60,000-member group acted out of frustration with current insurer-run managed care plans and a desire to bring out reforms that permit patients to choose the physician or surgeon. At the time, Murray emphasized that the college had not endorsed any specific single-payer bills that were pending then in Congress and had a number of significant differences with the former leading contenders which had been sponsored by Rep. Jim McDermott MD (D. Wash.) and Sen. Paul Wellstone (D. Minn) (Mcllarth, 1994). However, testifying subsequently before the House Committee on Education and Labor, Dr. Murray said that single-payer approaches probably present the best assurances that patients could seek care from any physician they choose and that single-payer approaches could probably be made more simple and administratively workable (Cotton, 1994). Again, that time, Dr. Murray expressed concern about the extensive power that would have been granted to health insurance purchasing under the now defunct Clinton administration's "managed competition" health care reform package, HR 3600 (Ibid.). These concerns were shared by others (Geisel, 1993; Wagner, 1993). (ABSTRACT TRUNCATED)     

Health care providers' knowledge about contraceptive evidence: a barrier to quality family planning care?

Background

The underuse of effective contraceptive methods by women at risk for unintended pregnancy is a major factor contributing to the high rate of unintended pregnancy in the United States. As health care providers are important contributors to women's contraceptive use, this study was conducted to assess provider knowledge about contraception.

Study Design

Bivariate and multivariate analyses were performed using data collected from a convenience sample of health care providers (physicians, nurse practitioners and physician assistants) at meetings of the professional societies of family medicine and obstetrics and gynecology.

Results

Younger providers were more knowledgeable, as were obstetrician/gynecologists, female providers and providers who provide intrauterine contraception in their practice.

Conclusions

The lack of consistent and accurate knowledge about contraception among providers has the potential to dramatically affect providers' ability to provide quality contraceptive care for their patients, which could have an impact on their ability to prevent unintended pregnancies.     

Health education: a boon to humanity or a fantasy and fraud?

The health education profession in the United States has been influenced by three major forces in recent years: sociomedical phenomena resulting in a public demand for health education, disease specificity of the practice of health education, and the process of professional credentialing. While these three forces are looked upon by many as beneficial to the profession, they also pose significant threats to the viability of the profession. Health educators must deal with these threats if the health education profession is to significantly benefit humanity. Otherwise, the profession may be ultimately perceived as a fantasy and fraud.     

What happens to retirees after health care reform?

The advent of health care reform may cause older workers, no longer fearful of losing health benefits, to leave their jobs. Employers that want to retain these valuable employees may ultimately need to upgrade pay and benefits.