Nobody's money : introducing choice-card, an innovative and comprehensive approach to the financing of health care

The need to attempt some type of control on the cost of medical care has become rather generally accepted. What hasn't been agreed upon how this will be done in the long term. The current means of attempting control without the need of significant government intervention is the pro-competitive environment which is initiating sweeping changes, and is showing some early promise of reducing the rapidity of medical cost increase. Prepaid medical care is being emphasized as hold the key to this problem. In these systems we are relying on the physician to be both provider and rationer of care while entitling the patient to all "necessary" medical care. The patients have for many years been conditioned by the medical system to a perception of necessary medical care. The medical profession, however, is not as readily able to define necessary care, but has been given the responsibility to deliver it. As these new systems increase, an adversarial role is developing between doctor and patient. From the vantage point of nearly 25 years as a family physician, studying the response of patient and provider to the incentives of the system; the author has formulated a unique system of medical care financing. This system will employ a voucher concept, cost-effective incentives built in the reimbursement structure for both physician and patient. It provides for a maximum of patient choice as the patient and his physician work as a partnership to define and obtain necessary medical care. This concept is explained; logic for its theoretical basis is given. It is analyzed from the standpoint of the principles of the Health Policy Agenda for the American People and in view of cost containment and health policy literature. Some suggestions of possible approaches to implementation are also made.