During the 1992 presidential election campaign, one of the key issues was the crisis in the U.S. health care system. The United States each year was spending more than 14 percent of its Gross Domestic Product -- more than $800 billion -- on health services, and the cost of those services was rising faster than the Consumer Price Index. Despite having the costliest health system in the world, however, the United States was far from providing health services for all of its citizens. Nearly 37 million Americans had no health insurance, and millions of others risked losing their access to health services if they changed jobs or became unemployed.(1)
When President Clinton took office in January 1993, he made it clear that legislation designed to reform the health care system and resolve some, if not all, of these problems would be one of the most important items on his domestic policy agenda. He appointed a commission, led by First Lady Hillary Rodham Clinton, to prepare a comprehensive health reform bill, which was unveiled before Congress and the American public in September 1993. Nearly five months later, in his first State of the Union address, Clinton still was insisting that Congress pass legislation that would "guarantee every American private health insurance that can never be taken away." But by the end of 1994, the President and Congress members alike had to admit that comprehensive health care reform legislation was dead -- not because the crisis in the U.S. health care system had resolved itself, but because policy-makers could not agree on a solution.
Despite the failure of comprehensive national health care reform legislation, however, the U.S. health care system is changing. According to a recent study of health care in 15 communities across the United States, important organizational changes have begun taking place, and the pace of change is both accelerating and broadening. Managed care -- a system in which health care delivery and financing are more closely integrated than in the traditional fee-for-service system -- has become far more common in communities nationwide. The study also showed that change is being driven by external forces, including a more competitive economy across the board and voters' desire to maintain or expand benefits without higher taxes, resulting in "strong pressures on both private and public purchasers to limit their health care costs."(2)
As these changes continue and even accelerate, it will be more and more important for the American public to have access to information about the organization, delivery and financing of health care; information that can help them to understand how the changes will affect their access to care, the quality of care they receive and the costs they will pay.
Traditionally, the U.S. news media have served as key sources of health care information for the public, but studies of public reliance on the news media as sources of health information have focused on information about medical problems such as cancer, heart disease and environmental risks. Likewise, most research on the content of health care coverage has focused on specific diseases or health problems, such as cancer or AIDS. The study this paper describes was intended to assess the quality of information daily newspapers provided about the structural aspects of the health care system -- the organization, delivery and financing of health services -- during a year in which the political agenda brought these issues to the forefront of national attention.
Data from the U.S. Health Care Financing Administration suggest that changes in the health care system may be having some effect on overall health care spending, which grew more slowly in 1994 than at any time in the past 30 years. Between 1988 and 1992, health care spending grew at double-digit rates, but the rate of growth dropped to 7 percent for 1993 and further, to 6.4 percent, for 1994. …