Health Insurance and Public Policy: Risk, Allocation, and Equity

By Miriam K. Mills; Robert H. Blank | Go to book overview

PART I
OVERVIEW OF HEALTH POLICY IMPACTS

Part I of this volume considers health policy broadly by examining the congressional setting and competing proposals. Chapter 1 examines alternative approaches to the finance of health care. Given the huge numbers of uninsured and underinsured individuals, great pressures are placed on society to provide equitable care. Broyles, Reilly, and Jones provide a thorough assessment of eight proposals for cost containment, each of which offers a varied approach to administrative structure and design. Some emphasize prospective payment mechanisms, whereas others consider compensating providers.

Broyles, Reilly, and Jones indicate that market pressures encourage providers to compete for patients as well as for physicians. Attracting these groups can result in significant increased costs for equipment and technicians. Broyles et al. suggest the advantages of a prepayment program, as well as cost containment of annual salaries. While nationalized health insurance is a feasible option, there is currently still much opposition.

Chapter 2 by Hinckley and Hill suggests that while it is difficult enough to predict the actions of individual congressional members, the collective behavior is even more difficult to predict. Several alternative descriptive frameworks have received wide currency, and the authors examine those developed by Davis, Dempster, and Rodolfsky; the issue of typology originated by Lowi; and the closely related cost-benefit assignment approaches expressed by Wilson in 1973. Practical events, however, expose the weaknesses in theory. Incrementalism has suffered from changes within the budget environment of the 1980s. These events raise serious questions about

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