The Canadian and U.S. health care systems: profiles and policies.

Comparisons are made in this article between the Canadian and U.S. health care insurance and delivery systems. Canada has universal, comprehensive, and publicly funded health insurance for medically necessary hospital and physician services. The United States does not. Aggregate health care expenditures for both countries are examined as are those for the hospital and physician services sectors. Policy differences between both systems, including system models, health insurance financing, resource commitment and control, and service limits, are presented. Observations are made regarding two elements of the Canadian model--prospective physician sector and prospective hospital global budgeting--and whether they are transplantable to the United States.

Should Medicare's trust fund be removed from the budget?

The recent proposal to to roll back the recent increase in the Social Security payroll tax has some health care executives worried. The Hospital Insurance Trust Fund is closely linked to the Social Security fund, and what affects one will surely affect the other. However, analysts say that the question of whether the trust funds should or should not be part of the federal budget masks a much bigger question. Are the Administration, Congress, and the American public ready to raise taxes to adequately fund Medicare?

Institutes of Quality experience uneven volume.

The Prudential Insurance Company's plan to shuttle patients needing high-tech care to designated Institutes of Quality was announced with great fanfare and has been under way for more than a year now. Yet the prestige of the designation has been greater than any increases in patient volume for all but a few hospitals involved in the program. Still, according to Prudential, the program has saved the Newark-based company close to $1 million.

Alternative strategies for controlling rising cesarean section rates.

Cesarean section rates in the United States have increased from 5.5% in 1970 to 24.4% in 1987. This dramatic increase has generated considerable concern, leading to a variety of proposals to control rising use of cesarean section. Six strategies have been adopted or proposed to reduce cesarean section use: (1) education and peer evaluation, (2) external review, (3) public dissemination of cesarean section rates, (4) changes in physician payment, (5) changes in hospital payment, and (6) medical malpractice reform. These strategies differ in their specific assumptions regarding the process of clinical decision making, implications for physician autonomy, and methods of implementation. Educational efforts have been the most widely promoted. Of these, formal programs aimed at modifying practices within individual hospitals appear to be the most successful. However, insufficient research has been conducted to compare conclusively the impact and feasibility of these six strategies, pointing to the need for further study.

Risk sharing: health care's latest challenge.

With pressure building to reduce healthcare costs, relations between providers and insurers in the years ahead increasingly will focus on risk sharing and utilization controls. Fixed price agreements and managed care plans are two approaches expected to come into wider use. To cope with coming utilization reviews and efforts to manage outpatient care, hospitals will need information systems allowing them to evaluate patient mixes and service intensities.

Aligning the backroom with the boardroom at Blue Cross/Blue Shield.

A recent survey of Blue Cross/Blue Shield organizations reveals fundamental differences in the attitudes and objectives of top management and information executives. Both groups learned valuable lessons for improving I/S effectiveness.

Empire Blue Cross and Blue Shield--the new image maker.

Imaging technology puts insurance claims processing in a new time dimension, and Empire Blue Cross and Blue Shield has invested in a system it hopes will reshape customers' image of a huge bureaucracy.

Physician participation in prepayment programs for the uninsured.

The problem of the growing number of uninsured increasingly affects physician practices. In Rochester, New York, a cooperative effort between hospitals, physicians, and the Blue Cross and Blue Shield Plan created an insurance program designed for low income uninsured patients. Modified benefits and subsidies from physicians, hospitals and Blue Cross and Blue Shield brought premiums to levels less than half of the rate for unsubsidized coverage. Steps undertaken in the product's development addressed physician concerns, and ensured physician participation sufficient to meet the needs of the program.