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Show HEALTHPRINT COMMENTARY ARTICLES The 1994 legislative session in Utah yielded the passage of health care reform legislation based on Governor Mike Leavitt's health care plan, Utah's HealthPrint. To better understand the implications of this reform, Utah's Health: An Annual Review solicited articles from three community members well versed in health care issues and requested their commentary on the implications of Utah's HealthPrint. HEALTH CARE REFORM: ARE WE HEADED WHERE WE NEED TO BE? by Kenneth N. Buchi, MD The delivery of health care in the United States has been an issue of great interest and discussion during the past decade. Major efforts are underway, driven by the Clinton administration, to "reform" the health care delivery system nationwide. Similar efforts have started in Utah with Governor Mike Leavitt's reform proposal outlined in "Utah HealthPrint: A Blueprint for Market Oriented Health Care." To assess whether these reform efforts will succeed in resolving some of the problems of our health care delivery system, it is useful to understand the evolution of our current health care system and why throughout that evolution it has failed to meet the needs and concerns of those who are most impacted by it: patients, health care providers, and those who pay for health care services. The purpose of this discussion is to identify some of the greatest areas of concern, how our current health care system evolved to allow their existence, and finally whether the Utah HealthPrint proposal for reform might adequately address those concerns by changing the incentives which led to their development. What Is The Health Care "Crisis"? Each of the major groups affected by the current health care system has a different view of why the health care system of the 1990's is in "crisis" and in need of reform. For the general public, the health care crisis is a "crisis" of uncertainty - uncertainty related in part to the complexity of modern health care delivery and the resultant difficulty for an individual patient to assess implications of decisions about health care which may need to be made personally or for family members. As patients we are concerned about whether we will be able to get appropriate care when needed, and whether we will be able to choose our own provider. We are concerned whether we will be treated with dignity and respect in the process of seeking and receiving care, and whether we will honestly be given the information we need to allow us to make appropriate personal choices. A further uncertainty is the fear that we may fall through the cracks in our current health care system because of a loss of insurance coverage or ability to pay for necessary care. This recognition that one's ability to pay for care is a frail thing that can be lost unexpectedly through the development of a serious illness, the unexpected loss or change of employment, the loss of insurance coverage, or the insurance company's simple refusal to provide coverage, has greatly increased the level of concern about our health care system among the majority of our citizens. The health care crisis as viewed by the payers, which are largely the businesses which provide health insurance coverage as an employee benefit, is a crisis of cost. The costs of providing all of the care which modern medicine is capable, to all of our citizens has simply outstripped the ability of the payers to pay. These costs also may outstrip the ability of our overall economy to allocate adequate financial resources to provide that care. Reform of health care has thus focused recognition on the fact that, given a finite limitation on resources, we cannot provide all care available to all who may want or need it. Therefore, we must somehow allocate health care services to fit the resources available. Finally, these discussions of allocation of health care services raise the third issue of concern from the health care provider community. This concern is that a crisis of the quality of care provided should not be allowed to develop because of limitations imposed by cost. How Did We Today's Health Care System: Get Here? There are several concepts and incentives which have interacted over the past decades to lead us into our current health care system. Principal among these is health insurance. The concept of health insurance is simple: as health care evolved during the early years of this century, it became medically possible to actually do things for patients which made a difference in the course of their disease and 112 HEALTHPRINT COMMENTARY |
