Academic journal article
By Ruskin, Andrew
St. John's Law Review , Vol. 73, No. 3
Although America's health care industry has undergone a tremendous evolutionary surge in the past decade, there is no indication that the pace of change will relax anytime soon. Before the pace could relent, the American public would need to he largely content with its health care system. Yet there are many signs that the public is still discontented with its care.1 The media are filled with reports concerning dissatisfaction of enrollees in managed care plans, the lack of choice of physicians imposed by their plans, and the delay or ultimate denial of payment for necessary care.2 Managed care has thus become a major focus of the criticism launched against the present health care system.3 All of the negative attention focusing on managed care has led to a general distrust of the present health care system, and a fear of eroding quality of the medical care provided in this country.4 Clearly, managed care is not the panacea for what ails the country's health care delivery system. Despite the problems wrought by managed care, it is also evident that the American public does not want to pay more for its health care.5 Thus, it is unlikely that there would be any public mandate in favor of returning to the costly fee-for-service health care system that preceded the inception of managed care.6 Neither extreme has succeeded in satisfying the American public.7 Therefore, the next evolutionary phase in health care will require empowering the American public to make the difficult choice between the denial of resources associated with managed care and the skyrocketing costs associated with fee-for-service medicine.
This Article proposes changes to the present health care system to allow the American people to maximize their satisfaction with their health care system by facilitating informed decisionmaking in their health care consumption choices. In most other markets, consumers are provided with choices among similar products that vary in cost and quality. From these choices, consumers can choose the product that most suits their preferences, thereby maximizing their satisfaction. If a potential patient were treated as a consumer, she also would be able to choose health insurance and health care delivery services based on price and quality, thereby increasing her satisfaction with the system.8 Due to the many obstacles in purchasing health care insurance and health care delivery services along price and quality lines, however, such satisfaction does not seem presently attainable.
After examining current health care market imperfections preventing price and quality choices within health care purchasing, and the historical trends that have created these imperfections, this Article proposes a system that seeks to correct these flaws, thereby facilitating satisfaction with health care consumption. Since the payment of insurance premiums accounts for most of the resources expended by consumers in procuring health care, this Article initially proposes offering consumers choices among different price levels at the time of enrolling in an insurance plan. These price levels would be tied to different levels of compensation to be paid to providers when administering care to the plan enrollees, which would correspond with different levels of expected efficacy of the treatment provided.9 As these levels would only reflect the intended efficacy level, this Article further proposes that health care providers be required to disclose their performance records in providing care as well as the costs incurred in achieving these results. The consumer could thus determine for herself whether the actual price and efficacy level of the treatment administered by a given provider meets with the consumer's expectations at the price level that she chose when she enrolled in the health plan. Through this encouragement of price and quality health care purchasing, it is expected that health care markets would more closely resemble other wellfunctioning markets. …