A social contract for 21st century health care: three-tier health care with bounty hunting.

Abstract

Health EconomicsVolume 5, Issue 6 p. 479-499 Guest EditorialFree Access A social contract for 21st century health care: Three-tier health care with bounty hunting Uwe E. Reinhardt, Corresponding Author Uwe E. Reinhardt James Madison Professor of Political Economy, Princeton University, USAWoodrow Wilson School of Public and International Affairs, Princeton University, Robertson Hall, Princeton, NJ 08544–1013, USA===Search for more papers by this author Uwe E. Reinhardt, Corresponding Author Uwe E. Reinhardt James Madison Professor of Political Economy, Princeton University, USAWoodrow Wilson School of Public and International Affairs, Princeton University, Robertson Hall, Princeton, NJ 08544–1013, USA===Search for more papers by this author First published: November 1996 https://doi.org/10.1002/(SICI)1099-1050(199611)5:6<479::AID-HEC228>3.0.CO;2-NCitations: 14AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 Levit, K. R., Lazenby, H. C. and Sivarjan, L. Health spending in 1994: slowest in decades, Health Affairs, 1996; 15(2): 130– 44. 2 Schieber, G. J., Poullier, J. P. and Greenwald, L. M. Health system performance in OECD countries, 1980-92, Health Affairs, 1993; 100– 112. 3 See, for example, Ellwood, P. M., Enthoven, A. C. and Etheridge, L. The Jackson Hole initiative for a twenty first century American health system, Health Economics, 1992; 1(3): 149– 68. 4 President Clinton's Health Care Reform Proposal and Health Security Act, as presented to Congress on October 27, 1993, Chicago, Ill.: Commerce Clearing House, Inc., Report No. 773, November 1, 1993. 5 Azevedo, D. Will the States get tough with HMOs?, Medical Economics, 1996; 73(16): and Guglielmo, W. ‘How health plans are fighting back,’ Medical Economics, 1996; 73(16). 6 This section draws on Reinhardt, U. E. Turning our gaze from bread and circus games, Health Affairs, 1995; 14(1): 33– 6. 7 See, for example, Reinhardt, U. E. and Taylor, H. Does the system fit? Health Management Quarterly, 1991; pp. 2– 10. 8 In this connection, see, for example, Bradsher, K. Gap in wealth in U.S. called widest in west, The New York Times, April 17, 1995; p. A-1 and D4. 9 See, for example, Inequality: for richer, for poorer, The Economist, November 5, 1994; pp. 19– 21. 10 Friedman, M. Gammon's law points to health care solution, The Wall Street Journal, November 12, 1991. 11 U.S. Bureau of the Census, Statistical abstract of the United States 1994, 114th. edition, Washington, D.C. 1994; Table 708, p. 464. 12 Reinhardt, U. E. Economics, Journal of the American Medical Association, 1996; 275(23): 1802– 4. 13 This section draws on Reinhardt, U. E. Rationing health care: What it is, what it is not, and why we cannot avoid it, in S. H. Altman and U. E. Reinhardt (eds), Strategic choices for a changing health care system, Chicago, Il.: Health Administration Press, 1996; pp. 63– 100. 14 Hadley, J., Steinberg, E. P. and Feder, J. Comparison of uninsured and, privately insured hospital patients, Journal of the American Medical Association, 1991; 265(3): 374– 9. 15 Kellerman, A. L. Too sick to wait, Journal of the American Medical Association, 1991; 266: 1123; Baker, D. W. and Stevens, C. D. Patients who leave a public hospital emergency department without being seen by a physician, Journal of the American Medical Association, 1991; 266: 1085; Bindman, A. B., Grumbauch, K., Keane, D., Rauch, L. and Luce, J. M. Consequences of queuing for care at a public hospital emergency room, Journal of the American Medical Association, 1991; 266: 1091. 16 Will, G. F. The Clinton's lethal paternalism, Newsweek, February 7, 1994, p. 64. 17 President Clinton's Health Care Reform Proposal and Health Security Act, as presented: to Congress on October 27, 1993. Published by the Commerce Clearing House, Inc., Chicago, Ill., as Report No. 773, November 1, 1993; p. 15. 18 The weirdest year, The Economist, November 5, 1994. 19 Fuchs, V. R. The health sector's share of the gross national product, Science, 1990; 247: 534– 538. 20 If X0 denotes the fraction of the GNP absorbed by health care in some base year and d denotes the percentage-point by which the continuously compounded growth rate of health spending exceeds the continuously compounded growth rate of the rest of the GNP, then, if that differential d persists into the indefinite future, the fraction Xt of the GNP absorbed by health care in some future year t is given by Xt = edt/(edt - 1 + 1/X0). 21 Schieber, G. J., Poullier, J. P. and Greenwald, L. M. op. cit. 22 Welch, W. P., Miller, M. E., Welch, H. G., Fisher, E. S. and Wennberg, J. H. Geographic variation in expenditures for physicians' services in the United States, The New England Journal of Medicine, 1993; 328: 621– 27. 23 Roughly speaking, government currently pays for 44 percent of all personal health spending in the United States; employer-provided private insurance pays for about one third. 24 Berk, M. L. and Monheit, A. C. The concentration of health expenditures: an update, Health Affairs, 1992; 11: 145– 149. 25 Schieber, G. J., Pouillier, J.-P. and Greenwald, L. M. Health spending, delivery, and outcome in OECD Countries, Health Affairs, 1993; 12: 112– 9, esp. Exhibit 4, p. 124. 26 Levit, K. R., Lazenby, H. C. and Sivarjan, L. op. cit. 27 Congressional Budget Office, Trends in health spending: An update, Washington, D.C.: U.S. Government Printing Office, June 1993; Table A-3, p. 51. 28 Myerson, A. R. Helping health insurers say no, The New York Times, March 20, 1995. 29 In this connection, see Reinhardt, U. E. Spending more through cost control: our obsessive quest to gut the hospital, Health Affairs, 1996; 15: 145– 154. 30 Nordheimer, J. New mothers gain 2nd day in hospital: Whitman signs a bill to fight curbs on care, The New York Times, June 29, 1995; p. B1. 31 Blendon, R. J., Donelan, K., Leitman, R., Epstein, A., Cantor, J. C., Cohen, A. B., Morrison, I., Moloney, T., Koeck, C. and Levitt, S. W. Physicians' perspectives on caring for patients in the United States, Canada and West Germany, The New England Journal of Medicine, 1993; 328: 1011– 22. 32 Eddy, D. M. Practice policies—what are they? The Journal of the American Medical Association, 1990; 263: 877– 878, 880. 33 For an excellent summary of many of the studies yielding this finding, see Brook, R. H. and Vaiana, M. E. Appropriateness of care, Washington, D.C.: The National Health Policy Forum, George Washington University, June, 1989. 34 The excluded physicians total about 56 physicians per 100,000 population. In this connection, see Rentmeester, K. and Kindig, D. Physician supply by specialty in managed care organizations. Testimony given before the Physician Payment Review Commission, December 9, 1993. 35 United States Statistical Abstract 1990 (Table 55). 36 Weiner, J. P. Forecasting the effects of health reform on U.S. physician requirements: Evidence from HMO staffing patterns, Journal of the American Medical Association, 1994; 272: 222– 30. 37 For a more thorough critique of current, federal ‘health workforce’ policy, see the author's Planning the nation's health workforce: Let the market in, Inquiry, 1994; 31: Fall, 250– 63. 38 See Reinhardt, U. E. Will physicians take back medicine?, Physician Executive, August, 1996 (forthcoming). 39 Fronstin, P. The decline in health insurance and labor market trends, Statistical Bulletin, 1996; 77: 28– 36. 40 Ellwood, P. M., Enthoven, A. C. and Etheridge, L. op. cit. 41 Somers, H. M. and Somers, A. R. Major issues in national health insurance, The Milbank Memorial Fund Quarterly, 1972; April: 177– 210. 42 Enthoven, A. and Kronick, R. A consumer-choice health plan for the 1990s, The New England Journal of Medicine, 1989; 320: 29– 37 and The New England Journal of Medicine, 1989; 320: 94– 101. 43 See the Health Insurance Plan of California, The HIPC Employee Brochure and Application, 1993 and 1995. 44 See, for example, Berwick, D. The globalization of health care, in Quality Connection, 1996; 5: 1– 2. Quality Connection is a newsletter published by the Institute for Health Care Improvement in Boston, MA. In this editorial, Berwick deplores the penchant among Americans to brush aside as irrelevant to the American experience the performance of health-care facilities abroad that appear to be able to deliver health care of a high quality at costs much below those of comparable American facilities. 45 See, for example, the National Committee on Quality Assurance, HEDIS 3.0—The Health Plan Employer Data & Information Set, Exposure Draft developed under the Auspices of the Committee on Performance Measurement, Washington, D.C.: July, 1996. Citing Literature Volume5, Issue6November 1996Pages 479-499 ReferencesRelatedInformation