Who Will Pay? the Economic Realities of Health Care Reform

Article excerpt

Stevens' paper contributes to an increased awareness of nurses' responsibilities toward access to care. The paper is well documented to enhance the premise that everyone in the United States is entitled to health care. While the author identifies several strategies that can and must be carried out in order to influence change, the paper lacks clarity in the more practical aspects of economic realities such as who will pay for these increased services.

In placing pressure on groups such as health care institutions, insurance companies, and government to make changes, we fail to recognize that the general public still has not indicated a willingness to pay for universal access to health care. While most polls show interest in expanding health care coverage to include the uninsured and underinsured, less than a majority of individuals have indicated a willingness to pay more than $100 to expand coverage to these groups (Hart/Teeter Poll, 1991). It seems apparent that an educational campaign will thus be necessary to convince the general public of the need for more comprehensive state and national health care programs for which each citizen will have to pay, even if indirectly through taxes.

One area that should be identified for research and practice is the economics of cost/benefit analysis. As nurses, we are responsible for assuring that each dollar spent is spent wisely and that supplies and equipment are not wasted. Inefficiencies in care must be identified not only to improve the quality of care but to reduce the cost. Economic necessity dictates that even if we were to achieve a consensus about universal access to health care, we would need to couple this with economical nursing practice. Too few nurses are willing to be a part of this solution by utilizing research and practice to identify outcomes of care linked to best practice. Yet these activities must be a part of the future of nursing, if we are to achieve the necessary savings to provide for expanded coverage.

Insurance companies are attempting to work with state insurance commissions as well as the federal government to secure relief so that they can adequately offer insurance options to small group employers. Current regulatory controls over the insurance industry have prevented the latter from being able to adequately respond to consumer needs. By understanding these issues, nurses can join with consumer groups and insurance organizations in lobbying to change the excessive regulatory environment.

Employers everywhere are experiencing significant increases in their health care benefits programs. While they are spending many more dollars than before as a percent of total payroll, they are also asking employees to share the burden by assuming increased co-payments and deductibles, as well as increased premiums. This awareness of the cost of health care has created the current climate of concern regarding not only access to care, but also the spiraling cost of health care delivery.

A careful study of other countries' systems of universal health care indicates that countries with universal health care are also struggling with issues such as cost and access. For example, the growth in actual per capita spending between 1980-1987 shows that Canada, with a 9.9% compound annual growth rate, is actually ahead of the United States with its 9.4% rate, while the United Kingdom trails slightly with 9.3% (Scheiber & Poullier, 1989). …