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Outlines developments in US health care, 1945-1990s, identifying a power shift from the providers of care, eg, hospitals & physicians, working closely with medical suppliers, to the payers supplying the funds & insurers receiving money from the payers & reimbursing the providers. From 1945 to 1970, insurers & providers forged a pact that helped funds flow easily from the payers of care to the insurers, providers, & suppliers. The economic deterioration of the 1970s & 1980s clashed with the public's desire for the most up-to-date diagnosis & treatment, but business & government became instrumental in limiting the money going toward health care. Based on changes in health care in San Francisco, CA, several trends are discussed. 47 References. C. Whitcraft

The widespread cutbacks in state & local soc services, the freezing of gov employee wages, & the lay-offs of public personnel reflect the deepening fiscal crisis of the state in the 1970's. This is occurring at a time when tens of millions of people in the US are becoming increasingly dependent on gov for educ & soc welfare services, & 11 million people are employed at federal, state, & local levels. To meet the needs of public sector workers & clients, taxes must be raised to pay for wages & services. The taxpayers revolt places the state in profound crisis. To explain the paradox of the poverty of the public welfare sector in the midst of an immensely wealthy society, the 2-fold relationship between the gov & the corporate rich must be explored. Firstly, the gov undertaxes the corporate rich & shifts the burden of taxation on to the poor & Wc; secondly, the gov uses public funds to allocate considerable subsidies to the corporate rich. The income tax is minimally progressive because wages are fully taxed, stocks & other investments are partially taxed, & interest from municipal bonds is not taxed at all. Soc security payments are regressive because they are based on payroll taxes on wages, only & the employers' portion is actually borne by the wage earner or the consumer. Similarly, the burden of the corporate income tax is shifted on to workers through decreased wage gains, & consumers through raised prices. Sales & excise taxes, especially on basic staples, are very regressive. The most inequitable tax of all is the property tax, falling largely on tenants & small homeowners. In order to build an effective movement to oppose the gov's role in the maldistribution of wealth, clients, public workers & taxpayers must reject narrow, divisive plans, & demand higher wages & increased services paid for by the taxation of the corporate rich. A. Karmen.

Understanding Health Policy: A Clinical Approach is a book about health policy as well as individual patients and caregivers and how they interact with each other and with the overall health system. We, the authors, are practicing primary care physicians-one in a public hospital and clinic and the other, for many years, in a private practice. We are also analysts of our nation's health care system. In one sense, these two sides of our lives seem quite separate. When treating a patient's illness, health expenditures as a percentage of gross domestic product or variations in surgical rates between one city and another seem remote if not irrelevant-but they are neither remote nor irrelevant. Health policy affects the patients we see on a daily basis. Managed care referral patterns determine to which specialist we can send a patient; the coverage gaps for outpatient medications in the Medicare benefit package affects how we prescribe medications for our elderly patients; and differences in access to care between families on Medicaid and those with private coverage influences which patients end up seeing one of us in the private sector over the other in a public hospital. In Understanding Health Policy, we hope to bridge the gap separating the microworld of individual patient visits and the macrouniverse of health policy.

Enthält Rezensionen u.a. von: Barry, Tom ; Preusch, Deb: The soft war: The uses and abuses of U.S. economic aid in Central America. - New York/N.Y. : Grove Press, 1988. - 304 S

The performance of medical groups is receiving increased attention. Relatively little conceptual or empirical work exists that examines the various dimensions of medical group performance. Using a national database of 693 medical groups, this article develops a scorecard approach to assessing group performance and presents a theory-driven framework for differentiating between high-performing versus low-performingmedical groups. The clinical quality of care, financial performance, and organizational learning capability of medical groups are assessed in relation to environmental forces, resource acquisition and resource deployment factors, and a quality-centered culture. Findings support the utility of the performance scorecard approach and identification of a number of key factors differentiating high-performing from low-performing groups including, in particular, the importance of a quality-centered culture and the requirement of outside reporting from third party organizations. The findings hold a number of important implications for policy and practice, and the framework presented provides a foundation for future research.

Frontmatter -- Contents -- Preface to the Second Edition -- Introduction -- Part I The Uninsured, Health Care Costs, and Public Programs -- The U.S. Health Care System: On a Road to Nowhere? -- Wanted: A Clearly Articulated Social Ethic for American Health Care -- From Bismarck to Medicare—A Brief History of Medical Care Payment in America -- The Sad History of Health Care Cost Containment as Told in One Chart -- The Unsurprising Surprise of Renewed Health Care Cost Inflation -- The Not-So-Sad History of Medicare Cost Containment as Told in One Chart -- Medicaid and Medicare: The Unanticipated Politics of Public Insurance Programs -- PART II Managed Care, Markets, and Rationing -- Bedside Manna -- Must Good HMOs Go Bad? The Commercialization of Prepaid Group Health Care -- Defending My Life -- Business vs. Medical Ethics: Conflicting Standards for Managed Care -- The Prostitute, the Playboy, and the Poet: Rationing Schemes for Organ Transplantation -- Ethics of Queuing for Coronary Artery Bypass Grafting in Canada -- Rationing in Practice: The Case of In Vitro Fertilization -- PART III International Perspectives and Emerging Issues -- Reforming the Health Care System: The Universal Dilemma -- Health Care in Four Nations -- Keeping Quality on the Policy Agenda -- What's Ahead for Health Insurance in the United States? -- Luxury Primary Care— Market Innovation or Threat to Access? -- Correspondence: Response to ''Luxury Primary Care'' -- Limiting Health Care for the Old -- Scapegoating the Aged: Intergenerational Equity and Age-Based Rationing -- Index to Authors -- About the Editors