Today's Healthcare And The Changes Expected For The Future From Hospital Care To Managed Care

Introduction

On an international basis, the development of health care policy is increasingly being influenced by cost considerations. Advances in health science and the delivery of care continue to expand the capabilities of treatments. The ability of nations and communities to pay for this care from available resources is a major subject of debate.

One focus of this debate has been research comparing health care utilization in Europe and the United States. Research has frequently demonstrated that, while Europe has greater capacity and higher utilization of services than the United States, Americans are paying more for these services. This discussion has intensified as nations on both sides of the Atlantic struggle to provide health and other programs while maintaining economic stability.

Frustrating as they may be for health care providers and payors, this situation presents important opportunities for research concerning health care policy. In particular, the experience of the United States during recent years, contains significant economic challenges with direct implications for health care financing and delivery. After eliminating federal budget deficits during the 1990s, America has generated a new round of shortfalls (exceeding $400 billion) annually through a combination of international military involvements and an economic downturn. This situation may impact Medicare, the major source of health care funding for the elderly and the largest single payor for these services. (Hoadley 143-54)

Resource limitations are also challenging other major health care payors in the United States. Private insurance has carried the burden of cost shifting from public payors and has also suffered from the impact of the economic recession . The Medicaid program, which funds health services for the indigent and elderly, has been challenged by budget difficulties of many state governments. (Levit 147-59)

The pressures that are being exerted by these developments on the health care system of the United States promise to create opportunities for policy making concerning cost containment during the immediate future. The Bush Administration is already rediscovering Medicare managed care . This type of activity could spill over to into other areas of the economy as the administration struggles to reconcile the costs of international commitments and domestic programs with its recent tax reductions.

Beyond these circumstances, current and future approaches to cost containment in the United States need to be viewed in a broader context. Managed care for a variety of payors was once seen as an effective approach to supporting health care quality while containing costs. During the past decade, the attractiveness of this approach to many employers has faded and prospects for limiting health care expenses have become confused . These developments caused payors in America to look in other directions for approaches to containing health care expenses. (Anderson: 89-105)

Discussion

Historically, managed care evolved in the United States to influence the use of medical care by improving outcomes and efficiency. The past three decades of experience with this approach suggests that at least some of these objectives have been realized. (Reinhardt: 169-81)

During the second half ...