Access, Cost, Quality Issues Strangling U.S. Health Care: Keith

By Carrell, Steven | Drug Topics, March 23, 1992 | Go to article overview

Access, Cost, Quality Issues Strangling U.S. Health Care: Keith


Carrell, Steven, Drug Topics


"Do these pills have any side effects, aside from bankruptcy?"

That "Herman" cartoon capsulizes just one major problem facing the nation's health-care system, said Stephen Keith, M.D., senior director of health-care delivery policy at Merck & Co. Inc.

His solution? "All health-care providers should provide the best care for all, with universal coverage, seeking the most value for the money." He said Merck will increase lobbying efforts for improved access to health care, through universal coverage, "because it is a disgrace the United States is one of two industrialized countries (besides South Africa) without universal access."

The recession is forcing growing numbers of people to join the 31 million to 37 million who already have no health insurance. They increase the ironic problem of inadequate access in a nation where health care annually costs $2,600 per person. This is a third higher than the cost in any other nation, Keith noted during a speech at the University of Texas-Austin.

Yet access and cost are just two of three major problems strangling the U.S. health-care system, he went on. Despite the high cost of care and the availability of the best technology, inconsistent quality is rampant. He cited as an example the ninefold difference between the number of coronary artery bypass surgeries in New Haven, Conn., and Boston--with no difference in patient outcomes.

Rather than push a specific comprehensive plan for fixing the nation's health-care problems, Keith outlined several possible scenarios; among them were a couple of variations of universal care with a public-private payment mix. "I don't know which (scenario) will happen," he said, but he did predict several definite trends:

* More pluralistic health-care coverage, with a range of systems such as fee for service or managed care;

* A decrease in the number of health insurance companies (currently 1,500), thanks to shrinking profits;

* Individuals' paying more for access to care;

* Use of a resource-based relative value scale by private insurers and other payers;

* More money for ambulatory and chronic care, replacing payments for inpatient care;

* Evaluation of the cost-quality ratio of care by everyone, including consumers. …

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