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Please click here to access San. MMCD All Plan & Policy Letters - Subject Listing A - D . Policy Letters are preceded by 'PL. Is national health insurance . Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. Doctors in the Veterans Administration and the Armed Services are paid this way. The health systems in Great Britain and Spain are other examples. But in most European countries, Canada, Australia and Japan they have socialized health insurance, not socialized medicine. The government pays for care that is delivered in the private (mostly not- for- profit) sector. This is similar to how Medicare works in this country. Doctors are in private practice and are paid on a fee- for- service basis from government funds. The government does not own or manage medical practices or hospitals. The term socialized medicine is often used to conjure up images of government bureaucratic interference in medical care. That does not describe what happens in countries with national health insurance where doctors and patients often have more clinical freedom than in the U. S., where bureaucrats attempt to direct care. Won't single payer bankrupt the U. S.? No, single payer will actually save money by slashing wasteful bureaucracy and adopting proven- effective cost controls like fee schedules, global budgets for hospitals, and negotiating drug prices with pharmaceutical companies. The savings - over $5. It turns out that it is much more expensive to keep patients away from health care in our current fragmented, market- based system than to provide care to all under an administratively simple single payer system. Administrative overhead (also known as . A recent paper on hospital administrative costs found that they consume 2. U. S. Reducing hospital administrative costs to Canadian levels would save $1. Over the long- term, controlling the rise in health inflation saves even more money. Without reform, the U. S. A recent study found that 4. Americans die every year because they don’t have health insurance. Many more skip treatments that their insurance company refuses to cover. Other countries do not ration in this way. If there is this much rationing, why don’t we hear about it? And if other countries ration less, why do we hear about them? The answer is that their systems are publicly accountable, and ours is not. Problems with their health care systems are aired in public; ours are not. For example, in Canada, when waits for care emerged in the 1. Parliament hotly debated the causes and solutions. Most provinces have also established formal reporting systems on waiting lists, with wait times for each hospital posted on the Internet. This public attention has led to recent falls in waits there. In U. S. No one takes full responsibility. Rationing in our system is carried out covertly through financial pressure, forcing millions of individuals to forgo care or to be shunted away by caregivers from services they can’t pay for. The rationing that takes place in U. S. A number of studies (notably a General Accounting Office report in 1. Congressional Budget Office report in 1. Administrative costs are at 3. U. S. These inflated costs are due to our failure to have a publicly financed, universal health care system. We spend about twice as much per person as Canada or most European nations, and still deny health care to many in need. A national health program could save enough on administration to assure access to care for all Americans, without rationing. See also: http: //www. Who will run the health care system? There is a myth that with national health insurance the government will make the medical decisions. But in a publicly financed, universal health care system, medical decisions are left to the patient and doctor, as they should be. This is true even in the countries like the U. K. Cost containment measures are publicly managed at the state level by elected and appointed agencies that represent the public. This agency decides on the benefit package and negotiates doctor fees and hospital budgets. It also is responsible for health planning and the distribution of expensive technology. Thus, the total budget for health care is set through a public, democratic process. But clinical decisions remain a private matter between doctor and patient. What about medical research? Much current medical research is publicly financed through the National Institutes of Health. Under a universal health care system this would continue. For example, a great deal of basic drug research, for example, is funded by the government. Drug companies are invited in for the later stages of “product development,” the formulation and marketing of new drugs. AZT for HIV patients is one example. The early, expensive research was conducted with government money. After the drug was found to be effective, marketing rights went to the drug company. Medical research does not disappear under universal health care system. Many famous discoveries have been made in countries with national health care systems. Laparoscopic gallbladder removal was pioneered in Canada. The CT scan was invented in England. The treatment for juvenile diabetes by transplanting pancreatic cells was developed in Canada. It is also important to note that studies show that, in the U. S., the number of clinical research grants declines in areas of high HMO penetration. This suggests that managed care increasingly threatens clinical research. Another study surveyed medical school faculty and found that it was more difficult to do research in areas where high HMO penetration has enforced a more business- oriented approach to health care. Finally, it appears that the increasing commercialization of research is beginning to slow innovation. Drug firms’ increasing reliance on contract research organizations (and for- profit ethical- review boards) has coincided with a sharp drop in innovative new drugs and a spate of “me- too” drugs - minor variations on old drugs that offer little benefit other than extended patent life. Won’t this just be another bureaucracy? The United States has the most bureaucratic health care system in the world. Over 3. 1% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, etc. Provincial single- payer plans in Canada have an overhead of about 1%. It is not necessary to have a huge bureaucracy to decide who gets care and who doesn’t when everyone is covered and has the same comprehensive benefits. With a universal health care system we would be able to cut our bureaucratic burden in half and save over $3. How will we keep costs down if everyone has access to comprehensive health care? People will seek care earlier when chronic diseases such as hypertension and diabetes are more treatable. We know that both the uninsured and many of those with skimpy private coverage delay care because they are afraid of health care bills. This will be eliminated under such a system. Undoubtedly the costs of taking care of the medical needs of people who are currently skimping on care will cost more money in the short run. However, all of these new costs to cover the uninsured and improve coverage for the insured will be fully offset by administrative savings. In the long run, the best way to control costs is to improve health planning to assure appropriate investments in expensive, high- tech care, to negotiate fees and budgets with doctors, hospital and drug companies, and to set and enforce a generous but finite overall budget. Will bundled payments and . They have been disappointed with models such as accountable care organizations, and they are now turning to MACRA and its alternative payment models (APMs), with a renewed surge of interest in bundled payments. The concept behind bundled payments is that, by assigning a single fee to a given intervention such as a joint replacement, you will motivate physicians to not spend money on portions of the care that are not really necessary. Medicare, as the payer, gets the advantage of a discounted price, and the physicians and hospitals get to keep whatever they save beyond the discount. Does this really reduce volume? The joint replacement will be done regardless, so what volume will be reduced? Doing only a cursory pre- op exam, missing the ejection murmur and omitting the pre- op cardiac consult? Send a patient home earlier when it is possible that the post- op status might not be fully stabilized? Cut back on rehabilitation, risking a less favorable long term outcome? These might reduce volume, but they certain bring into question quality and thus value. Now they want to pay a set bundled payment for a heart attack. The clinical course of a heart attack is highly variable and could involve only a few or a great many interventions. Under a bundled payment, the physicians and hospital are bearing the risk of the high costs of a potentially complicated, protracted course. Isn’t it the role of the insurer, in this case Medicare, to pool risk? Shifting that risk to the health care delivery system creates the potential for either a reduction in important beneficial health care services, or exposing the delivery system to potential monetary losses and the risk of insolvency - neither of which are desirable. Perhaps an even more important issue is the fallacy that you can bundle most care and thus make strides in bending the cost curve. Think of the current proposals to bundle coronary artery bypass grafts and to bundle care for a heart attack - one might work some of the time, but the other has outcomes that are too variable. Facebook. Entfernen. Wir verwenden Cookies, um Inhalte zu personalisieren, Werbeanzeigen ma. Wenn du auf unsere Webseite klickst oder hier navigierst, stimmst du der Erfassung von Informationen durch Cookies auf und au. Weitere Informationen zu unseren Cookies und dazu, wie du die Kontrolle dar.
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