Can It Be-More Health-Care Bureaucracy?

By Pretzer, Michael | Medical Economics, May 11, 1998 | Go to article overview

Can It Be-More Health-Care Bureaucracy?


Pretzer, Michael, Medical Economics


The President's commission on health-care quality thinks so.

The final report of the Clinton-appointed President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry-I dare you to speak the name in one breath-falls within the grand tradition of commission work. It's replete with lofty ideas, obfuscatory language, pulled punches, and a call for more bureaucracy. Further, it has the potential to suffer the traditional fate of commission reports: shelved, then forgotten.

You may recall that this past winter the commission issued what it called a Consumer Bill of Rights and Responsibilities. All Americans, according to the commission, are entitled to: information about their health plans and providers, a sufficient selection of providers, emergency services, participation in decisions about their medical treatment, respect and non-discrimination, confidential communications with providers, and internal and external appeals of a health-plan's decisions. At the same time, Americans have the responsibility to involve themselves in decisions and policies that affect their health care.

The commission's final report contains a throng of recommendations that are supposed to turn the rights and responsibilities into reality and improve the quality of health care nationwide. But will Washington and the nation's health-care complex take the suggestions to heart?

The commission's report couldn't begin more innocuously. The "first step" down the path to quality care is a "clear statement of purpose." To wit, the commission proclaims: "The purpose of the healthcare system must be to continuously reduce the impact and burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States." It won't make a catchy slogan (functioning?), but it's a tune that Democrats and Republicans, fee-for-service doctors and HMO executives, insurance companies and consumer groups could all sing-if they chose.

In the report, the commission promises that it "has not taken a position on the best way to achieve full implementation of the Consumer Bill of Rights (i.e., statutory or regulatory approaches vs. more voluntary approaches)." Thus, it judiciously avoids recommending specific legislative and regulatory initiatives. I'd have to say, however, that steering clear of legislative proposals suggests a preference for the use of market forces. The commission adds that it "does not propose the creation of additional regulatory entities."

What it does propose is the creation of two entities that, I guess, the commission considers to be non-regulatory. They are the Advisory Council for Health Care Quality, and the Forum for Health Care Quality Measurement and Reporting. (That's a commission, a council, and a forum; where are the nomenclature police when you really need them?)

The council is to be a public-sector organization not unlike the Medicare Payment Advisory Commission, which counsels Congress on Medicare financial matters that relate to physicians and hospitals. According to the Clinton commission, the council "would focus on defining, updating, tracking, supporting, and reporting on national aims for [health-care quality] improvement," and it "would track the industry's efforts to establish . . . the Consumer Bill of Rights and Responsibilities." It would report to the president and Congress annually.

The commission would give the council a mouth but no muscle. "There are concerns on the part of some about creating too strong a public-sector role that could stifle innovation," reads the final report. "This clearly is not the commission's intent. The advisory council's role should be limited to one of providing advice and guidance."

The forum, on the other hand, is to be a private-sector venture, an organization of people who represent group insurance buyers, consumer organizations, health-care providers, labor unions, and quality-oversight organizations; it would also include health-care researchers and industry and pubic health experts. …

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