Comprehensive Health Insurance Research Articles

Are Medical Education Dollars Buying What They Should?

WHETHER or not it sticks in the craw, by federal mandate, health planning does exist, as do the specter of comprehensive national health insurance plans, and the Federal Trade Commission with its alledged assaults on professionalism. There are watch birds set up to control utilization and quality through Professional Standard Review Organizations, audits, and utilization review committees; the $2.7 billion authorized for health professions education by the new health manpower law comes with many strings attached. The public, at least in its federal form, has increasingly been involved in health care and medical education. I was asked to speak for the public interest. I cannot legitimately speak for all my fellow citizens. We even have difficulty according our highest popularly elected officials the power to speak for us. So, with that disclaimer, I will speak about medical education dollars and the public interest. DOLLARS, DISTRIBUTION, DISAFFECTION, AND QUALITY The key

Prospects for a national health service or for comprehensive health insurance.

Prospects for a national health service or for comprehensive health insurance.

Health and Medical Care: Selected Data Sources

One of the leading indicators of the quality of human life is health and access to medical care. Increasing social concern over the problems of health has resulted in various nationwide proposals like medicare and medicaid. At present, many bills are pending before the United States Congress for the creation of a comprehensive national health insurance scheme. One result of this public awareness is the demand in many libraries for information on the various aspects of the health care industry in general and in particular, on health legislation, resources and facilities, prices and costs and insurance. The following survey aims to examine certain leading publications which provide statistical and other types of information in this area. Excluded from this survey are sources dealing specifically with clinical aspects of drugs and medicine. Moreover, additional and uptodate information on the specific topics discussed below can be obtained by consulting subject indexes like the Hospital Literature Index and the Insurance Periodicals Index.

The Impact of National Health Insurance on the Tasks and Practice of Psychiatry

Psychiatry, like all professions, is strongly affected by changes in societal expectations and economic forces. Changes in professional priorities and patterns of patient care will undoubtedly be brought about by national health insurance. Two major types of national health insurance have been proposed: comprehensive health insurance and catastrophic insurance. We do not anticipate major impact on psychiatric tasks from some form of catastrophic insurance. Comprehensive health insurance would shape and change psychiatric practice. An examination of psychiatric tasks provides a framework for anticipating alterations in practice. We identify four major task areas in psychiatry: (1) medical tasks, (2) reparative tasks, (3) social control tasks, and (4) humanistic tasks. These tasks would be differentially influenced. Psychiatry's medical tasks will be stressed, while funding for many reparative tasks may be limited. The care of the severely ill patient may be fragmented because of problems in integrating medical and rehabilitative services.

The Comprehensive Health Insurance Plan

The Comprehensive Health Insurance Plan

National Health Insurance Proposals: Their Effect on Family Planning and Other Preventive Health Services

The Nixon Administration Comprehensive Health Insurance Act of 1974 (H.R.12684, S.2970), Kennedy-Griffiths Health Security Act of 1973, (H.R.22, S.3), the Long-Ribicoff-Waggonner Catastrophic Health Insurance and Medical Reform Act (H.R. 14079, S.2513) and the Mills-Kennedy Comprehensive National Health Insurance Act of 1974 (H.R. 13870, 3286) are compared with respect to general concept, coverage of population, benefit structure, financing, cost sharing, administration, provider standards and the effect on existing programs. Family planning services and well-child care are not included in the group of services which are regarded as essential under the Mills-Kennedy or administration proposals. Both bills exempt these services from a general provision which limits coverage to curative care and services. The Long-Ribicoff bill mandates the provision of family planning counseling, services and supplies for the low income population as defined in the bill but limits coverage to other persons to catastrophe-related care. The "model policy" of the bill does not mention family planning or well-child services.

Physician service in Montreal before universal health insurance.

We report here the results of three surveys conducted during 1969-70 as part of the first phase of a before and after study of the introduction of comprehensive health insurance in the Montreal metropolitan area. 1. Household Survey. In a survey of a random sample of 6,000 households over a 12-month period, no direct relationship was found between family income and use of physician service. However, an adjustment of family income for family size and composition resulted in a direct relationship with higher income families receiving more services than the lower; this relationship was particularly strong for children. In an attempt to see if the higher volume of services in high income families reflected greater need, symptoms of disease thought to require physician care were studied. These were found to be about the same for children in various income groupings but more frequent among adults in lower income groups. It was concluded that there were unmet needs for physician services in Montreal prior to the introduction of comprehensive health insurance and that these were related to income levels. 2. Work of Physicians. Interviews with a random sample of 497 practicing doctors in Montreal, between October 1969 and May 1970, showed that the average working day ranged from 9.7 hours for general internists to 11.7 hours for psychiatrists. The number of patients seen, excluding telephone consultations, ranged from 70 patients per week for psychiatrists and to 140 patients per week for general practitioners. 3. Use of Emergency Rooms. Interviews were conducted with 1,766 patients who attended emergency rooms in six Montreal hospitals for reasons other than an accident within 24 hours and with 1,694 who attended outpatient departments in two hospitals. The majority (83 per cent) of the emergency room patients interviewed had non-urgent conditions. Of those attending the two outpatient departments, 61 per cent claimed this as their usual source of care, and 70 per cent came without referral by a physician. While 70 per cent thought that continuity of physician care was important, two thirds said they would prefer the outpatient department even if all medical care were free. These three surveys are being repeated in 1971-72 approximately one year after the introduction of comprehensive health insurance.

Some perspectives concerning federal health legislation.

In response to growing public concern about the cost, availability, and accessibility of personal health services, the Congress is almost certain to enact a rather broad national health insurance plan within the next several years. The important features of the debate leading to enactment of national health insurance will involve the issues of comprehensiveness of insurance coverage and private vs public financing mechanisms. Advocates of a public financing mechanism contend that the private, voluntary health insurance sector is incapable of providing equitable, comprehensive health insurance benefits. They believe that it is only through a comprehensive public financing mechanism that true public accountability can be achieved. Growing concern is being generated within the Congress by the inability of elected and appointed officials, charged with the responsibility for administering publicly financed but partial health insurance programs (eg, Medicare, Medicaid), to control costs and utilization of services. In addition to the passage of

Mental health services through national health insurance.

The president of the United Automobile Workers Union poses problems that the mental health professions must deal with in helping to solve the general crisis in health care facing the nation. Major reasons for the crisis are discussed, and the Health Security Program, aimed at providing comprehensive national health insurance services for all Americans, is outlined.

1944-1945 Programs for Postwar Social Security and Medical Care

S OCIAL SECURITY and employment' are looked upon, in all Allied Nations and also in most neutral countries, as the keys to economic well-being in the postwar era. Improved labor standards, economic advancement and social are the economic objectives of the Atlantic Charter. All these terms are somewhat vague in meaning, but they express the hopes of hundreds of millions of people and are central in all postwar planning. Even while the war was in progress, considerable improvement was made in the social security legislation of many countries.2 This is not true of the United States, in which there was no social security legislation whatsoever on the national level during the five years between the enactment of the Social Security Act Amendments of I939 and the passage of the Servicemen's Readjustment Act (the G. I. Bill of Rights) in I944, except for the adoption of annual riders to appropriations acts which provided for freezing of the old-age insurance tax rates. Some advances were made in the states, particularly in the liberalization of unemployment compensation benefits. But the only law in this country which broke new ground was the Rhode Island Act of 194I for cash disabilitv benefits. In many other countries, in contrast, the war period brought forth much new social security legislation. The advances in this respect have been greatest in the Latin American countries. Very significant new social-security legislation also has been enacted in England, Canada, and Australia, while in New Zealand the comprehensive national health insurance and medical-care program adopted shortly before the outbreak of hostilities has been put into full operation. More important even than the new legislation are the comprehensive programs for social security which were developed during the war. Prior to I 944, such postwar programs were formulated and publicized in England, the United States, Canada, Australia, and South Africa all of them under governmental auspices.3 The most famous of these was the Beveridge Plan in England, which made its appearance late in I942.4 Beyond question, this has been the most widely-discussed social security program ever advanced anywhere in the world. In this country it has brought forth far more articles than were written about the Social Security Act during the entire year that this major American social security measure was in preparation and under consideration in Congress. Almost immediately after its publication, the