Intro | Private Ins. | Medicare | Medicaid | Managed Care | Crisis | Reform
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American Health Care at the End of the Twentieth Century
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The health systems of the democracies of the world have evolved in the twentieth century in response to both political dynamics and technological change. While nations may learn from one another, none can create a health care system that is an exact replica of another's. To visualize the shape fundamental health care reform in America might take, it is critical to have an understanding of the major building blocks of modern American health care.
The three major payers for health services in the United States are employment-based private insurance, Medicare and Medicaid. The history, current activities, and current policy issues of each are outlined below.
The fourth section of the overview is about managed care. This is not exactly parallel to the first three. Over the last decade, managed care has become the dominant force in American health care. Many say that it has fundamentally transformed the health care system. It is not only a way of paying for care, but a way of organizing care. Prior to the advent of managed care, insurers, whether public or private, passively paid the bills submitted by health care providers with little questioning. Managed care organizations actively manage their budgets, determining practice patterns as well as reimbursement rates. The payers are no longer taking a back seat; they are now driving the health care system.
The health care insurance muddle has actually created a crisis in American health care. We are due, and overdue, for significant reform.