employees in 1983, including dental and vision care. But it scrapped its full coverage plan in 1984. In its place, Goodyear introduced a plan in which salaried employees (mainly management) and some unionrepresented workers pay the first $100 of medical expenses and 15 percent of the remaining eligible expenses, up to $1,000 each year. Goodyear is not alone in pursuing efforts to reduce health bills. A large number of employers are moving away from first-dollar coverage, under which employees do not have to pay deductibles or copayments for health services used. According to a survey of more than 1,000 companies, conducted by the management consulting firm of Hewitt Associates, 63 percent of the firms had a deductible for in-patient hospital services, while only 30 percent required such ayment in 1982. Cost cutting by both the private and ublic sectors is inescapable in today's economic climate in which Americans spend more than $1 billion a day on health care. The business community, which picks up a out one-third of the cost (and even more when sick leave is added), is respo ding by becoming a more prudent purchaser of health benefits. It is developing more costeffective payment arrangements with providers and shifting services away from the most expensive segments, such as hospital care, toward lower-cost settings, such as outpatient clinics. Who should pay the burden of cost containment measures that af-
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Mar 1, 1986
R J Marsh 
Open Access
