The changing US Health Care System: Challenges for responsible public policy

Authors
Citation
M. Gold, The changing US Health Care System: Challenges for responsible public policy, MILBANK Q, 77(1), 1999, pp. 3
Citations number
90
Categorie Soggetti
Public Health & Health Care Science
Journal title
MILBANK QUARTERLY
ISSN journal
0887378X → ACNP
Volume
77
Issue
1
Year of publication
1999
Database
ISI
SICI code
0887-378X(1999)77:1<3:TCUHCS>2.0.ZU;2-8
Abstract
The "managed care backlash" arguably topped the list of media and policy co ncerns in 1998. Yet, against the background of the highly charged environme nt in which the future of our health care system continues to be debated, t here is a dearth of concrete, "objective" faces on the nature of the change s, the reasons for them, and their meaning. An analysis of five important t hemes that emerged from a review of the recent literature on health system change concludes that an inherent tension exists between the interest in ra pidly driving down health care costs through organizational change and the long time frames that are required to make fundamental changes in structure , process, and orientation. Unfortunately, in an environment in which purch asers are driven to seek cost savings and the political will supports a plu ralistic and mixed public/private system, the health system may chart an al ternative course, with the result that purchasers may rely increasingly on individual cost sharing and continue to cut back the amount of coverage the y are willing to offer. The real challenge for public policy makers is to c onfront the issues directly, avoiding political incentives to adopt easy an d fast solutions for these complex matters.