MANAGING THE HEALTH-CARE SYSTEM UNDER A GLOBAL EXPENDITURE LIMIT - A WORKSHOP SUMMARY

There is ongoing debate as to whether global budgets, or expenditure l imits, are compatible with a strategy for managed competition. The Rob ert Wood Johnson Foundation sponsored an invitational conference for p ublic and private policymakers to discuss the issue. The meeting's pur pose was to explore how global expenditure limits might work and what their implications would be for costs, access, and quality of health c are. This article summarizes the ideas presented at the conference, lo oking in particular at global expenditure limit models in Germany and Canada. Overall, the papers and presentations at this meeting demonstr ated that global expenditure limits have the potential to provide the necessary fiscal discipline to manage the health care system and provi de a greater degree of certainty and accountability for payers, provid ers, and patients. However, it is also clear that without a common set Of principles about the role health care should play in our society a nd an agreed upon framework of governance for the system, it will be d ifficult for the United States to resolve the detailed and complex imp lementation and administrative issues of a reformed health care system .