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Show Allocation of Resources/Removal of Barriers: Utah HealthPrint should get mixed reviews on this front. Plans are to progressively expand the population eligible for Medicaid coverage, beginning in 1994, by increasing coverage for all teenage children living below the federal poverty level, and eventually, if funding is available, to all Utahns below poverty with a subsidy for those between 100-150% of poverty level incomes. Initial 1994 steps also require that dependents up to age 26 remain covered by family health insurance plans. These two steps will help remove financial barriers to access for large portions of our Utah population. Utah HealthPrint effectively ignores the fair resource allocation issue. However, the stated goal of Utah HealthPrint is not to assure some guaranteed level of health care for all Utahns, but rather to "increase access to affordable insurance coverage for all Utahns" (Exec. Summary, p. 1). This insurance coverage will likely have at least some designated level of benefits for which the insurance will pay, but is far from an acknowledgment that there is some minimal level of care which should be assured for all. Hopefully, as (and if) Utahns become involved in the process of reform outlined by Utah HealthPrint, some effort will be made to directly address how we feel about a guaranteed level of care, as Oregonians have been doing for the last several years. Many of the difficult issues slated for study and report by the Health Policy Commission, such as rural health care, ethical decisions/issues, public health, and long-term care, among others, will be difficult to resolve effectively without general agreement on this key issue. In summary, Utah HealthPrint should at this early stage receive mixed reviews. It has recognized and started to correct some of the incentives in health care which have led to an inappropriate, costly, and confusing system of health insurance. Utah HealthPrint also makes some positive strides towards decreasing financial barriers to care through expanding Medicaid eligibility and through some of the proposed and actual insurance reforms. Most importantly, Utah HealthPrint outlines a process and a timeline for moving forward to address and resolve our health care concerns. One could argue that insurance reform could move ahead more quickly, but this is a first step and the plan is in place to move ahead steadily. We as a community of Utahns can take advantage of the outlined process to expand the discussion to the large issues of concern still yet to be addressed. Through cooperative dialogue we can decide whether or not everyone has a right to some level of health care and, if we agree that everyone does, then our next decision is what our attendant responsibilities are to assure the availability of that level of care. About the Author Dr. Buchi is the Associate Chief of Staff for Ambulatory Care at the Salt Lake Veterans Administration Medical Center, and Clinical Associate Professor of Internal Medicine at the University of Utah School of Medicine. He has worked extensively with the Utah Legislature, the Utah Democratic Party, and the Utah Medical Association in various areas of public policy related to health and the environment. Dr. Buchi currently serves on the Legislative Task Force looking at the role of Clinical Practice Guidelines in health care reform; the Medicaid Technical Advisory Group for the Utah Health Policy Commission; the Salt lake County Environmental Quality Advisory Commission. He is also the Vice-Speaker of the Utah Medical Association's House of Delegates, the president of the Utah Society of Internal Medicine, and the president-elect of the American Cancer Society, Utah Division._____________________________________________ References Cassell, Christine K. 1993. Personal Communication. U.S. Department of Health and Human Services. 1992. Improving Access to Health Care through Physician Workforce Reform: Directions for the 21st Century. Third Report: Council on Graduate Medical Education. Utah's Health: An Annual Review 1994 115 |