The Health Policy Agenda: Some Critical Questions

The Health Policy Agenda: Some Critical Questions

The Health Policy Agenda: Some Critical Questions

The Health Policy Agenda: Some Critical Questions

Excerpt

Sweeping and profound changes are taking place in this country's financing and delivery patterns for medical care. Leaving behind the days when a health care payment system was often described as an open-ended, blank-check arrangement, Americans have entered an era when prudent purchasing has become the rallying cry for both public and private payers of care. From a widely held perception that more is always better in the realm of health care services, we have now arrived at a keen awareness that we live in a world of limited resources, a place where trade-offs must be made.

Whereas in the recent past the federal government sought to play a leading role in designing the shape and direction of the nation's health care system, today it wants to limit its fiscal exposure and, to that end, has granted the states and the private sector significantly more flexibility and power to reform health care and contain costs. Although many people have greeted the greater influence of market forces as a welcome trend, society in general continues to believe that health care is a special commodity, one that should be treated differently from other goods and services in our economy.

These often contradictory dynamics have ushered in a time of considerable flux and uncertainty. In an environment of constraints, how will resources be allocated among the rich and poor, among providers and consumers of care? What should be the role and responsibility of government in a more market-oriented environment? The essays in this volume attempt to shed light on some of these compelling questions by looking at premises that have guided health policy in the past and by examining several alternative approaches that have been put forward as more appropriate for today's realities.

The first two chapters in the book address what has become an issue of primary concern. Health care, some have observed, is becoming a membership affair; those without the financial wherewithal to pay for medical services may increasingly be denied access. Estimates . . .

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