Standards for thoracic surgical oncology in a single-payer healthcare system.

Through systematic literature review and a consensus-based approach from an expert panel, standards on the organization for delivering thoracic cancer surgery in a single-payer healthcare environment were developed. Thirty-two studies and six organizational reports were identified. Results from 32 studies showed a trend toward higher volumes and improved patient outcomes, and six consensus reports provided recommendations on thoracic care standards. Thoracic surgical oncology standards in a single-payer healthcare system were developed. The benefits associated with the implementation of thoracic cancer surgery standards should result in increased regionalization of care, improved processes of care, and better patient outcomes.

Proposal of the Physicians' Working Group for Single-Payer National Health Insurance.

The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet more than 41 million Americans have no health insurance. Many more are underinsured. Confronted by the rising costs and capabilities of modern medicine, other nations have chosen national health insurance (NHI). The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs that, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar. We endorse a fundamental change in US health care--the creation of an NHI program. Such a program, which in essence would be an expanded and improved version of traditional Medicare, would cover every American for all necessary medical care. An NHI program would save at least 200 billion dollars annually (more than enough to cover all of the uninsured) by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Physicians and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules, often designed to avoid payment. National health insurance would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run. An NHI program is the only affordable option for universal, comprehensive coverage.

Decentralization in a sick fund: lessons from an evaluation.

In 1988, Israel's largest sick fund embarked on a process of decentralization, which consisted of the delegation of authority from central management to two regions that were chosen as demonstration sites. Aims to examine the extent to which the decentralization plan was implemented, to identify the major difficulties in implementation and to evaluate the process of implementing organizational change. Contends that the demonstration programme was implemented in part only, and that difficulties did arise during implementation. Our evaluation of the decentralization process led us to develop conceptual diagnoses of the various problems that might arise during decentralization and derive lessons for successful implementation. Evaluation taught us that when implementing a plan of decentralization, it is beneficial to make a clear division of responsibilities; develop control instruments and an information infrastructure; improve the skills of managers; appoint a team responsible for implementing decentralization, and establish a joint forum for working out problems between central management and sub-units; and clarify organizational policy on the central operational issues facing sub-units. Expresses the hope that the conclusions drawn here will help other organizations in Israel and abroad in planning and implementing decentralization.