Critical issues in American health care delivery and financing policy

476 Pages·1991·33.9 MB·English

by  United States. Advisory Council on Social Security (1989-1991)

1991
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ADVISORY
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SECURITY
American
Critical Issues in
Health Care Delivery
and Financing
Policy
December 1991
DC
Washington,

Critical Issues in American
Health Care Delivery
and Financing
Policy
A
Report of the
Advisory Council
on Social Security
December 1991
Washington, DC
MEMBERSHIP OF THE 1991 ADVISORY COUNCIL
ON SOCIAL SECURITY
Chair
Deborah Steelman, Esq.
Attorney-at-Law
Members
G. Lawrence Atkins, Ph.D. The Honorable James R. Jones
Director of Employee Benefit Policy Chairman and Chief Executive
Winthrop, Stimson, Putnam & Officer
Roberts American Stock Exchange
Robert M. Ball John Meagher
Former Commissioner of Parmer
Social Security LeBoeuf, Lamb, Leiby & McRae
Philip Briggs Paul H. O'Neill*
Vice Chairman of the Board Chairman and Chief Executive
Metropolitan Life Insurance Officer
Company Alcoa
Lonnie R. Bristow, M.D. Arthur L. Singleton
AMA
Board ofTrustees Consultant on Government
Theodore Cooper, M.D. John J. Sweeney
Chairman and Chief Executive International President
Officer Service Employees International
The Upjohn Company Union
Professor John T. Dunlop Donald C. Wegmiller
Harvard University President & Chief Executive Officer
Health One Corporation
Karen Ignagni
Director
Resigned, replaced by
Department of Employee Benefits
John Meagher.
AFL-CIO
si
STAFF OF THE 1991 ADVISORY COUNCIL
ON SOCIAL SECURITY
Ann D. LaBelle, D.D.S.
Executive Director
Barbara Cooper Olga Nelson
Adele Eley Mary Sue Olcott
Robert Lagoyda Teddi Pensinger
Arta Mahboubi Virginia Reno
Susan V. McNally Nancy Row
Brigitta M. Mullican Michael D. J. Zambonato
Hi

PREFACE
The 1991 Advisory Council on Social Security was appointed by Health and
Human Services Secretary Louis Sullivan in June 1989 to review the status of
the Social Security and Medicare trust funds, as well as to study a range of
health care issues, The Council convened 14 meetings, and to assist in the
Council's deliberations, substantive, scholarly investigations were undertaken on
a broad range ofhealth care issues. Issue analysis background materials were
developed to brief the Council members for their meetings and were used as a
starting point for debate.
Council members were consistently impressed with the quality and focus of
these documents, as well as the timeliness of their analysis. In the process, the
Council decided that this valuable information would be published for the
American public and those with particular interest in health care policy and
reform. This report contains 18 analytical papers which served as background
briefing documents for Council discussion and formulation of recommendations.
The papers represent a comprehensive look at health care issues as they appear
at the point in time during which the Council conducted its work.
This report is divided into three parts: Access, Cost Containment, and Health
Care Delivery in Other Countries. The Access section is further divided into
three categories: Problems of Access to Care, Innovative Approaches to
Expanding Access to Care, and Approaches for Financing Expansions in Access
to Care.
The Council thanks Judith Arnold, Jessica Miller, and David Kennell, who had
principal roles in this project. Other contributors include Lisa Alecxih, Daniel
V
N. Mendelson, Kevin Coleman, Robert Atlas, Gary Young, Harry Sutton, Louis
P. Garrison, Jennie Best, Mary Beth Fiske, Robert Friedland, Vera Kurlantzick,
Robyn Stone, and Leigh Ann White.
The Council also thanks David Cooper of the Office of the Assistant Secretary
of Planning and Evaluation for his many helpful suggestions, as well as Council
staffmembers Barbara Cooper, Robert Lagoyda, Susan V. McNally, Teddi
Pensinger, Virginia Reno, and Michael Zambonato, without whose work this
report could not have been completed.
Ann D. LaBelle, D.D.S.
Executive Director
Advisory Council on Social Security
vi
TABLE OF CONTENTS
EXECUTIVE SUMMARY 3
PART ONE: ACCESS 15
Problems of Access to Care 15
Profile of the Uninsured and Underinsured 17
Private Health Insurance 41
Public Health Insurance 73
The Role of Direct-Financed Services 103
The Problem of Long-Term Care 123
Innovative Approaches to Expanding Access to Care 139
Health Insurance Reform for Small Employers and
High-Risk Individuals 141
Medicaid Expansion 59
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The Role of Schools in Expanding Access to Care 175
State Initiatives to Expand Access to Care 193
Options for Financing Long-Term Care 211
Approaches for Financing Expansions in Access to Care 233
. .
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PART TWO: COST CONTAINMENT 289
The Problem of Rising Health Care Costs 291
Controlling the Costs of Administration 319
Containing Health Care Costs Through Supply
and Price Controls 335
Managed Care as a Cost-Containment Vehicle 355
Health Care Rationing 393
Cost Containment and Quality of Care 415
PART THREE: HEALTH CARE DELIVERY
IN OTHER COUNTRIES 431
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