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Show to encourage providers to organize into efficient delivery networks and can create incentives for efficient choices by their employees" (Blue Ribbon Committee on Health Care, 1992, p. 3). Third, the government should regulate health care markets in ways that facilitate private competition. Recognizing that market forces do not always have socially desirable outcomes, the Committee advocates a limited but critical role for the government to "manage" competition. The Committee report states that "competitive forces are not an effective tool for establishing overall limits on health care expenditures, and by its very nature, competition erodes cross subsidies which are the underpinnings of health insurance" (Blue Ribbon Committee on Health Care, 1992, p. 3). Specifically, the Committee calls for increased regulation of the small employer health insurance market and "development of a process to sanction provider collaboration to provide certain expensive high technology services.. .which function more efficiently as an oligopoly or natural monopoly" (Blue Ribbon Committee on Health Care, 1992, p.3). Finally, the state should promote healthy lifestyles in the general community. The Committee encourages medical providers to be concerned about the overall health of the community and not just providing medical care. The Committee argued that financial incentives "for individuals and providers need to be re-oriented toward improved health of the community" (Blue Ribbon Committee on Health Care, 1992, p.4). The Blue Ribbon Committee states its recommendations are focused on strategies to improve economic discipline through improved effectiveness of private markets. They recommend specific actions be taken by the private and public sectors. The fundamental private sector strategy proposed by the Committee is to establish employer health care purchasing coalitions. The Committee argues that by combining the claims information, analytical resources, size, and market power of several companies, demand forces can be organized in such a way that health providers will have to sell health care in the way employers want to buy it. Rather than relying on the current practice of seeking provider discounts, coalitions should focus on "negotiating fixed prices for defined 'packages' of services and identifying efficient providers for custom service delivery networks." The Committee believed that this fixed-price-for-a-defined-procedure purchasing method will result in better prices, lower administrative costs, and less excessive technology. The Committee also has several broad, multi-faceted recommendations for the public sector. First, the state government should reform the small group health insurance market to improve access to health care. Speaking to the Access to Health Care Task Force, Lawrence Lewin stated that while competition is good for most things, it is "socially blind." The effects of competition and risk avoidance in the small group market have created a volatile situation where small firms are not able to obtain affordable, stable coverage. Therefore, the state should step in and enact moderate regulation that encourages the small employer health care market to be conducted in more socially desirable ways (Lewin, 1992, p. 13). Other public sector strategies recommended by the task force include expanding the availability of Medicaid, enacting a provider conflict of interest law, expanding prudent purchasing in Utah's public health care programs, establishing standard benefit packages to promote valid price comparisons, reforming the medical liability system, and developing and encouraging the use of a universal claims form. Analysis and Comparison Asking the Right Questions In any analysis of health care reform proposals, it is important to assess their response to a few fundamentally important questions about what we want our health care system to be. First, we should answer the question, "Access to what?" Rather than focusing on whether health care is a right or a privilege, we need to first define Utah's Health: An Annual Review 1993 111 |
