RESUMO
In an effort to keep abreast of the changing needs of a more affluent society and to ensure better value for money, the British are reforming their National Health Service. They are promoting competition and entrepreneurship, and directing funding to follow a patient rather than flowing directly to institutions. British physicians are resisting these changes. The United States, in the middle of a health care crisis of its own, can learn a great deal from Britain, especially in the area of controlling expenditures. The low cost of the National Health Service can be attributed to four major factors: (1) It is general practitioner driven and no patient accesses a specialist or hospital directly. (2) Hospitals, which employ all the specialists and supply most of the technology, operate on very tight, cash-limited budgets. (3) Administrative costs are very low. (4) The expense of malpractice is not (yet) a major concern. Changes occurring in both countries foretell a future wherein our health care systems may look very much alike.
Assuntos
Medicina Estatal/normas , Controle de Custos , Competição Econômica , Educação de Pós-Graduação em Medicina/organização & administração , Empreendedorismo , Medicina de Família e Comunidade/organização & administração , Alocação de Recursos para a Atenção à Saúde , Gastos em Saúde/estatística & dados numéricos , Humanos , Imperícia , Medicina/organização & administração , Médicos/psicologia , Privatização , Opinião Pública , Especialização , Medicina Estatal/economia , Medicina Estatal/organização & administração , Reino Unido , Listas de EsperaRESUMO
An inexpensive plan is offered that provides access to basic, outpatient, primary, and preventive health care for all uninsured citizens of the State of New Mexico. New Mexicare rewards hospitals and hospital-affiliated specialists for inpatient care that is now unreimbursed. The establishment of a Health Care Trust Fund would create a mechanism that could influence the allocation of scarce and expensive resources to areas of need. New Mexicare would be set up within the State Medicaid Division and would be predicated on a mandate that all employers must provide health insurance with reasonable cost sharing by higher paid employees. It would not have great fiscal impact on small businesses, require complicated new tax rules, or impact current state revenues. New Mexicare solves the problem of the uninsured in incremental fashion and does not create an enormous administrative or budgetary burden to the state. It may be a suitable model for other states that share New Mexico's demography. New Mexicare could easily and rapidly be dissolved in the event that the federal government finally acts and provides universal access with some type of national plan.
