Magazine article Clinical Psychiatry News

MDs Wary over IOM's Health Care Reform Plan. (Demonstrated Projects)

Magazine article Clinical Psychiatry News

MDs Wary over IOM's Health Care Reform Plan. (Demonstrated Projects)

Article excerpt

Physicians are expressing concerns about an Institute of Medicine report that proposes several broad-based health care reforms via a series of nationwide demonstration projects.

Health and Human Services Secretary Tommy G. Thompson commissioned the work from an IOM committee. Pending government approval, the projects are intended to produce model delivery of care systems within 5 years. Some projects could begin as early as next year.

The demonstration projects provide "building blocks" to begin repairing the ailing health system, according to the IOM committee. The projects focus on five areas: expanding insurance coverage, reforming medical liability, establishing an information and communications (ICT) technology infrastructure, caring for the chronically ill, and reforming the delivery of primary care. A handful of states will participate in demonstration projects in each of these areas.

The committee said the demonstrations would prompt only modest increases in health care expenditures, but it did not provide cost estimates. All of the projects are intended to be budget neutral, although health insurance benefits will increase at the state level.

The fact that the TOM is focusing on such crucial reform issues is good news, said Dr. James C. Martin, president of the American Academy of Family Physicians. However, Dr. Martin and other experts expressed some concern about particular solutions proposed by the institute.

For example, Dr. Martin said the AAFP opposes the "incrementalist" approach to expansion of health benefits proposed by the IOM committee: The IOM's plan focuses on demonstration projects that would expand insurance on the state level through tax credits to be applied to an insurance plan, or through expanded eligibility for public insurance programs, or through a combination of the two.

This would provide basic care for some people, but would create an "incredibly fragmented" health care system in the end, Dr. Martin said. "Incrementalism only complicates things more."

The AAFP favors a system of universal coverage based on a broad taxing mechanism where every citizen would participate.

Internists, on the other hand, believe that the IOM's incremental approach is wise.

As long as it goes beyond tax credits, the TOM's proposal for expanding health coverage is in keeping with that of the American College of Physicians, said Dr. Sara Walker, ACP's president. "We believe pretty strongly any plan should be incremental. …

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