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Thursday, 15 July 2010
Learning Objective 1: Describe similarities between operating budgets in socialized health care systems and risk assumption by health care providers in the American health care system
Learning Objective 2: Describe how emphases on consumer/community control affect health care systems and health care providers and limit responses to a broad cross section of consumer needs
Methods: Three health care systems were reviewed: the British National Health Service, The Canadian Provincial health care system, and the American privatized health care system.
Results: Despite superficial differences, efforts to rationalize health care delivery and financing are promoting very similar characteristics within these national health care systems in terms of access, efficiency, responsiveness to consumer needs, and responses to aging populations are on far more convergent than divergent courses.
British efforts to establish community control and similar efforts to localize service delivery in some Canadian systems have correlates in the American system. All three systems shift the responsibility for managing the uncertain costs of health care services to smaller, less financially capable, and less inefficient settings. In the USA, the Prospective Payment systems and capitation-like mechanisms lead to conflicted ethical and financial relationships between providers and consumers, and efforts to deliver minimal care to meet the financial constraints of inefficient insurance operations.
Conclusion: Local control and decision-making and inadequate budgets for the risks assumed have predictable effects. Small insurers are less efficient, less capable, and must reduce benefits compared with large and remote insurance risk management. While end of the year costs may be lower than expected, providers cannot assume this throughout the year. Instead, they must reduce costs throughout the year to protect their full term capacity. Transferring insurance risks from large, capable insurers, whether public or private, to health care providers, reduces service capacities.
While local control has its appeal, local decisions can produce undesirable effects - responding to the needs of populations with more political and financial power and failing to address the needs of minorities without political or financial power, independent of the national system.