NOTES

CHAPTER 1

1. Among the many good books that describe other coun­tries' health care systems, one I would recommend is L. A. Graig, Health of Nations: An International Perspective on U.S. Health Care Reform (Washington, D.C.: Wyatt Com­pany, 1991). This book offers an accurate description of a few relevant countries including Canada, Germany, Ja­pan, the Netherlands, and the United Kingdom, as well as the United States. Another, briefer summary that is helpful is International Benefits: Part !-Health Care [Wash­ington, D. C.: Employee Benefit Research Institute (EBRI), 1990].

CHAPTER 2

1. Robert Pear, "One Trillion Dollars in Health Costs Pre­dicted," The New York Times, December 29, 1994, p. A12.

295

296 Notes

2. Robert J. Blendon and Humphrey Taylor, "Views on Health Care: Public Opinion in Three Nations," Health Affairs, 8(1}, 1989, pp. 149-157.

3. Sylvia Law, Blue Cross: What Went Wrong? (New Haven: Yale University Press, 1976), p. 68.

4. Ibid., p. 68. 5. Ibid., p. 69. 6. Paul Starr, The Social Transformation of American Medicine

(New York: Basic Books, 1982}, p. 296. This book offers a good description of both the emergence of Blue Cross and Blue Shield and their implications for the future of health care financing in the United States. See the sec­tion "Birth of the Blues," pp. 295-310.

7. Ibid., p. 297. 8. Ibid., p. 297. 9. Ibid., p. 296.

10. D. W. Light, Political Values and Health Care: The German Experience, eds. D. W. Light and A. Schuller (Cam­bridge, MA: MIT Press, 1986), pp. 4-5.

11. Ibid., p. 3. 12. M.G. Taylor, Insuring National Health Care: The Canadian

Experience (Chapel Hill: University of North Carolina Press, 1990), p. 34.

13. Ibid. 14. Ibid., p. 46. 15. Ibid., p. 17. 16. Ibid. 17. S. Andreopoulos, ed., National Health Insurance: Can We

Learn from Canada? (New York: John Wiley, 1975}, p. 15. 18. Ibid., p. 21. 19. A. C. Monheit and P. H. Harvey, Inquiry, Fall1993, as

reported in Health Benefits, November 15, 1993. 20. Pear, p. A12.

Notes 297

CHAPTER 3

1. It is difficult to make true comparisons regarding the number of uninsured since, over time, the definitions have changed somewhat. What the actual number of uninsured is at any given moment is hard to assess. Nevertheless, even though pinpoint estimates may be difficult to impossible, it is safe to say two things with fair certainty. First, whatever the number, it is too high, particularly when one considers that virtually no one is without insurance in other countries; and, second, the number of uninsured did increase significantly over the decade of the 1980s.

2. These data, from the Employee Benefit Research Insti­tute, were reported by Robert Pear, "What Is 'Universal' Is Center of Fight Over a Health Plan," The New York Times, February 16, 1994.

3. HIAA, "Employer-Sponsored Health Insurance in 1991" (Washington, DC: HIAA, 1922), p. 5.

4. This is a quote from an executive speaking at a private meeting. For obvious reasons, his identity will remain confidential.

5. The Center on Addiction and Substance Abuse at Colum­bia University is studying the cost impact of substance abuse on the entire health care system. While not com­pleted, they estimate that about 20% of all health care costs (in both the public and private sectors) can be attributed directly or indirectly to alcohol, tobacco, and illicit drugs. For more information see: J. C. Merrill, K. Fox, and H. Chang, The Cost of Substance Abuse to Amer­ica's Health Care System, 1993, available through the Center on Addiction and Substance Abuse at Columbia Univer­sity, New York, NY.

298 Notes

6. The author apologizes for the lack of a specific reference for this statistic. It is based on a World Health Organiza­tion document the author was privy to in 1982. Since I no longer have access to that document, no reference can be provided.

CHAPTER 4

1. "Boomer Town/ American Heritage, September 1993, p. 22. 2. E J. Turner, An American Primer, ed. D. J. Boorstin (New

York: New American Library, 1985), p. 545. 3. Ibid. 4. Ibid. 5. Ibid., p. 546. 6. Ibid., p. 544. 7. J. M. Burns, The Lion and the Fox (New York: Harcourt,

Brace & World, 1956), p. 264.

CHAPTER 5

1. Kathy Kiely, "Gramm Campaigning for GOP Health Plan," The Washington Post, October 14, 1993, p. A8.

2. Starr, p. 266. 3. Starr, p. 268. 4. Eric E Goldman, The Tragedy of Lyndon Johnson (New York:

Alfred A. Knopf, 1969), p. 288-293. 5. "Politics and Policy: Bush and Clinton Exchange Selves

on Health Care," The Wall Street Journal, August 8, 1992, p. A16.

6. The President's Health Security Plan (New York: Times Books, 1993), p. 11.

7. Henry Aaron and William Schwartz, The Painful Prescrip­tion (Washington, D.C.: Brookings Institution, 1984).

Notes 299

CHAPTER 6

1. Based on information from the "1994 Annual Report of the Board of Trustees of the Federal Hospital Trust Fund" (Washington, D.C.: 1994).

2. EBRI, p. 12. 3. Taylor, p. 23. 4. Graig, p. 192. 5. EBRI, p. 12. 6. Graig, p. 134. 7. Ibid., p. 194. 8. EBRI, p. 12. 9. Graig, p. 196.

10. Jay Wolfson and Peter Levin, "Health Insurance, Japa­nese Style," Business and Health, May 1986.

11. Colin Burrows, Australia, p. 119. 12. S. Altman and T. Jackson, "Health Care in Australia:

Lessons from Down Under," Health Affairs, 10(3), 1991, p. 134.

13. Ibid., p. 135. 14. EBRI, p. 12. 15. Ibid. 16. Health Care in the 90s: A Global View of Delivery and

Financing (Los Angeles: Blue Cross of California and the King's Fund, 1990}, p. 82.

17. Ibid. 18. Taylor, p. 147.

CHAPTER 7

1. This was from a speech by Willis Goldbeck, president of the Washington Business Group on Health, at a meeting

300 Notes

of the National Association of State Legislators in July, 1987.

2. Given the quote, anonymity is advisedly pr~served. It was part of a private conversation between this individ­ual and the author.

3. Again, understandably, there is a need for anonymity. This was said to the author in a private conversation with the head of one of that city's largest HMOs.

4. Peter G. Peterson, "For Health Insurance with No Frills," The New York Times Magazine, January 15, 1994, pp. 36-37.

5. Ibid., p. 37. 6. Taylor, p. 156. 7. For a good discussion of both the history and the actual

implementation of this funding methodology, read Tay­lor cited earlier. Chapters One and Nine are particularly enlightening on this subject.

8. This is extracted from a talk Professor Graf yon der Schulenberg gave at a conference on Health Care in the 1990s, sponsored by Blue Cross of California and the King's Fund of Great Britain in September 1990. This was reprinted in the report cited above, Health Care in the 90s: A Global View of Delivery and Financing, p. 98.

9. My memory dims with respect to the name of the administrator. It was said in January 1976, at Mai­monides Medical Center in Brooklyn, New York, shortly after ESP was lifted.

10. Health Care in the 90s, p. 99. 11. Ibid. 12. Craig, p. 83. 13. Ibid. 14. EBRI, p. 16. 15. Craig, p. 84.

Notes 301

16. J. Kosterlitz, "The United States Looks at Canadian Health Care," The National Journal, July 22, 1989, quoted in Graig.

17. Health Care in the 90s, p. 60. 18. Health Care Systems in Transition. 19. John K. Iglehart, "Japan's Medical Care System," New

England Journal of Medicine, September 22, 1988. 20. Altman and Jackson, p. 140. 21. Ibid.

CHAPTER 8

1. R. Toner, "Health Plan's Foes Tap Well of Public Fear," The New York Times, January 25, 1994, p. 1.

INDEX

Acquired immune deficiency syndrome (AIDS), 10, 34, 126, 159

competition between payers and, 45 private health insurance and, 38,

39, 41 social component of, 58-59

Administration costs, 54 Aetna, 187 Age, German private health insurance

and, 146-147 Alberta, Canada, 142, 208 Alcohol abuse, 10, 59; see also

Substance abuse All-payer systems, 47-48, 51, 52, 54, 55 Almshouses, 114 American Hospital Association

(AHA), 16, 17 American Medical Association

(AMA), 101 Australia, 106

cost containment in, 202, 256-258, 260

health care financing in, 151-154, 157

Australia (cont.) hospital reimbursement in, 256-258 pragmatics of cohabitation in, 79 private health insurance in, 43, 117,

120, 123-126, 152-154 Autonomy of providers, 77-78, 104-

105, 106, 223-227; see also Freedom of choice

AWBZ (Netherlands), 144-145

Balance billing, 239 Bare bones coverage, 157-159 Baylor University Hospital, 16, 21 Belgium, 57-58, 62 Benefits, 292-293

reduction in, 157-159 Beveridge, William Henry, 88 Bill of Rights, 84 Bismarck, Otto Eduard Leopold von,

19-20, 23, 170 Block grants, 207 Blue Cross, 19, 21, 104, 134, 143, 190,

288 competition with other payers, 45

303

304 Index

Blue Cross (cont.) cost-based reimbursement and, 242 cost containment and, 187, 224 High vs. Low Option plans of, 51 history of, 16-18 sickness funds (Germany)

compared with, 170, 172, 173, 175, 178

Blue Shield, 170, 224 history of, 17-19

Boomers, 81 Bouchard, Etienne, 20 British Columbia, Canada, 142, 208,

232-233 Bush, George, 67, 102, 106 Bypass surgery, 109

California Medical Association, 18 California Physicians Service, 18 Canada, 2, 13, 55, 62, 87-91, 102, 171,

265-266 administration costs in, 54 British influence in, 87-88 cost containment in, 194, 200-201,

202, 203, 207-209, 215, 225, 231-235, 239, 249, 250, 251, 252, 278-279

frontier in, 87 health care financing in, 130, 141-

143, 156, 157, 287 health care organization in, 166-170 history of health care system in,

20-23 hospital reimbursement in, 249,

250, 251, 252 physician reimbursement in, 231-

235, 239 private health insurance in, 120, 123 private sector in, 103, 106 rationing in, 194, 252 satisfaction with system in, 14 social responsibility in, 70 tax deductions in, 155

Canada (cont.) World War II and, 89, 90-91, 266 See also individual provinces of

Canadian Labor Congress, 89 Cancer, 39, 159 Capital expenditures, 249-251, 253,

254-255, 257 Capitation payments, 130, 131, 259

in Great Britain, 104, 164, 240 history of, 21 in Netherlands, 235-236, 240

Capping method, 233 Carter, Jimmy, 7 Catastrophic coverage, 145-146, 258 Central Office of Health Care Tariffs

(COTG), Netherlands, 235 Central Social Insurance Medical

Council Oapan), 219, 255 Central Social Medical Care Council

(CSMCC), Japan, 238-239 Charge-based systems, 189-190, 242,

246, 251 Checkoff plans, 21 Cherry-picking, 43 Clinton, Bill, 7-8, 36, 37, 91, 100, 103,

107, 113, 119, 131-132, 139, 142-143, 159, 181-182, 189, 193, 212, 258, 265, 267, 268, 281, 283, 287, 289

Coal miners, 19 Coinsurance, 49 Commission on the Costs of Medical

Care, 100 Community rating, 43, 132-133, 137,

139, 162 in Australia, 153-154 sickness funds (Germany) and, 143

Competition cost containment and, 196-197 in Great Britain, 164-166, 248-249, 258 managed, 181, 189, 268 in Netherlands, 258-259 public and private sector, 44-55

Index 305

Competition (cont.) regulation superiority to, 223-227

Computerized tomography (CT) scans, 238-239

Concerted Action (Germany), 76, 211-212, 214, 219, 220, 226, 252, 280

Connecticut, 157 Constitution (Canada), 87, 208 Constitution (U.S.), 85 Contract employees, 37 Cooperative Commonwealth

Federation (CCF), Canada, 89 Copayments, 49, 50 Cost-based systems, 189-190, 242,

246, 251, 254 Cost containment, 10-11, 107, 135,

165, 185-262, 274-280 beneficiaries of, 27, 191-195 cost-sharing and, 48-52 expectations of health care system

and, 195-199 expenditure caps in: see

Expenditure caps explicit expenditure level in, 206-210 lack of cooperation in, 187-191 last decade of, 185-186 participation in, 210-216, 219-221,

261, 280. uniform rules for, 221-222, 261-262,

291-292 See also Reimbursement

Cost-sharing, 48-52 Cost-shifting, 27, 76, 240

cost containment and, 188, 190, 191, 192, 279

employer-based systems and, 34 in hospitals, 247 income-based financing and, 160-

163, 282 Coverage rules (Canada), 166-167

Dedicated taxes, 132, 155, 159 Deductibles, 49, 50

Defense Department, U.S., 44, 137, 175

Demographic rating, 133 Depression: see Great Depression Deserving poor, 114 Diabetic woman, not covered, 12, 49,

112 Diagnosis Related Groups (DRGs),

243-244, 259 Dialysis: see Renal dialysis District health authorities (Britain),

164 Dole, the, 70 Douglas, Tommy, 89, 90 Drug abuse: see Substance abuse

Economic Stablization Program (ESP), 217-218

Economy, 272 importance of health care industry

in, 26-28, 192-193 Education, 25, 66, 84, 113, 119-120, 132 Elderly, 56-57

in Canada, 252 Medicaid and, 115, 116 Medicare cuts and, 282 in Netherlands, 58 rationing and, 109, 112, 252

Employer-based systems, 32-37 in France, 155 in Japan, 147-151 risk assumption in, 39 sickness funds (Germany) as, 173-

174 social responsibility and, 72-73, 77 subsidies for, 139-140 tax deductions for, 155-156 See also Self-insured plans

Employment, Retirement and Income Security Act (ERISA), 136

Entitlements, 85-86, 92, 117-118, 120 Exceptional Medical Expenses Act

(Netherlands), 144-145

306 Index

Expenditure caps, 206-210, 240, 259-260, 274-280, 283, 291

autonomy under, 223-227 in Germany, 44, 227-229 gradual phase-in of, 216-217 hospital reimbursement and, 247 participation in, 219-221 permanence of, 217-218 uniform rules for, 221-222, 291-292

Experience-rating, 39-40, 43, 132-133, 137, 162, 288

Family Leave Bill, 70-72, 113 Fee-for-service, 130, 131

in Canada, 234 in Germany, 228-229, 231, 277-278 in Japan, 238 in Netherlands, 236 in United States, 21

Financing: see Health care financing First dollar rationing, 112 Fixed budget reimbursement, 248,

252 France, 103, 106, 126

Canada influenced by, 88 cost containment in, 259 health care financing in, 131, 154-

155, 157, 159 hospital reimbursement in, 255 private health insurance in, 117,

121-122, 123, 153, 154-155 satisfaction with system in, 204 social responsibility in, 70 tax deductions in, 155

Freedom of choice, 106-113; see also Autonomy of providers

Frontier, 79, 80-86, 87, 91, 92-95, 272

Gay population, 59 General tax revenues, 160

in Australia, 152 in Canada, 156 in Great Britain, 75, 140-141, 156

General tax revenues (cont.) in Japan, 156 in Scandinavia, 156 in Sweden, 140-141 in United States, 130, 132

Germany, 13, 62, 102, 106, 126, 266 amount spent on health care in, 201 cost containment in, 196, 210-214,

216, 219, 220, 226, 227-231, 233, 235, 241, 252-254, 261, 277-278, 280

health care financing in, 133, 143-144, 146-147, 157, 162, 286-287

health care organization in, 170-179, 180-181, 182, 290, 291

history of health care system in, 19-20, 23

hospital reimbursement in, 252-254 physician reimbursement in, 227-

231, 233, 235, 241 private health insurance in, 43-44,

117, 122-123, 144, 146-147, 174-175, 176, 178

satisfaction with system in, 14, 204 social responsibility in, 76 World War II and, 271

Global budgeting, 244-246 Global payment, 245-246, 249, 256 Government Managed Health

Insurance System (Japan), 148, 149

Graig, Lawrence, 233 Gramm, Phil, 100 Grand coalition, 95 Great Britain, 62, 77

amount spent on health care in, 9, 201

Canada influenced by, 87-88 competition in, 164-166, 248-249,

258 cost containment in, 202, 203, 206-

207, 209, 225, 227, 240, 241, 248-249, 251-252, 253, 258

Index 307

Great Britain (cont.) criticism of health care system in,

100 freedom of choice in, 107 health care financing in, 131, 140-

141, 156 health care organization in, 164-

166, 287 hospital reimbursement in, 248-

249, 251-252, 253 physician reimbursement in, 240,

241 pragmatics of cohabitation in, 79 private health insurance in, 117,

120-121, 123, 125-126, 153, 203 private sector in, 103-104 rationing in, 13, 108-112, 251-252 social responsibility in, 75 World War II and, 266

Great Depression, 16-17, 18, 66, 95-96, 270, 271, 272-273

Great Society, 65-66 Greeley, Horace, 93 Gross domestic product (GDP), 200

in Canada, 170, 201 in Germany, 196, 210 in Great Britain, 9, 109-110 health care growth tied to, 216-217,

274-275 in United States, 5, 9, 11, 26, 192,

195-196, 216-217 Gross national product (GNP), 207,

260 Guild system, 143, 170 Gun control, 85

Head Start, 66 Health Alliances, 37, 166, 181-182,

267, 287, 289, 292 Health Care Act of 1984 (Canada),

231, 232 Health Care Cost Containment Act

(HCCC), Germany, 210-211, 231

Health care financing, 129-163, 182-183, 285-287

benefit reduction and, 157-159 income-based: see Income-based

financing reimbursement distinguished from,

130-131 subsidies in: see Subsidies in United States, 129-137

Health care organization, 163-183, 287-291

Health care right, 25, 42-43, 88-89, 91, 99-128

defining, 117-127 freedom of choice and, 106-113 public vs. private sector in, 102-106

Health insurance: see Employer-based systems; Private health insurance

Health Insurance Association of America (HIAA), 33, 267

Health Insurance for Employees (HIE), Japan, 148-151, 162

Health Insurance Societies (Japan), 149-150, 173

Health maintenance organizations (HMOs), 49-50, 259, 291

cost containment and, 190-191 financing of, 131, 134-135 first, 20

Health of Nations, The (Graig), 233 Heart surgery, 108, 112 Hip replacement, 112 Hospital reimbursement, 241-258

capital expenditures and, 249-251, 253, 254-255, 257

charge-based: see Charge-based systems

competition between payers and, 45, 47

cost-based: see Cost-based systems fixed budget, 248, 252 global budgeting, 244-246 global payment, 245-246, 249, 256

308 Index

Hospital reimbursement (cont.) per diem, 243-244, 251, 252-254 per discharge, 243-244, 246, 251 prospective approaches to, 242,

243-246, 248, 254-255 retrospective approaches to, 242-

243, 244, 246, 247, 253, 254 Hospitals, 106

almshouses distinguished from, 114 in Australia, 256-258 autonomy of, 223-227 in Canada, 166, 208, 249, 250, 251,

252 cost containment and, 190, 196-197,

206-207, 208, 217-218, 222, 223-227, 259, 278

employer-based system and, 35 in France, 255 in Germany, 252-254 in Great Britain, 206-207, 248-249,

251-252, 253 history of, 16-17 in Japan, 255-256 in Netherlands, 145, 254-255

Illiteracy, 60 Immunizations, 12, 56 Income-based financing, 138-157, 157,

266, 281-283 cost-shifting in, 160-163, 282 subsidies and, 139-140, 281-282

Income taxes, 131, 159 in Australia, 152 in Canada, 141 in Sweden, 140-141 in United States, 131

Individualism, 66, 80, 83, 84, 95, 97, 272 Individual rights, 72-78, 84-85 Industrial Revolution, 19 Infant mortality, 9, 10, 58, 59-60, 203 Inflation, 37, 260 Insulin, not covered, 12, 49, 112 Italy, 203-204

Japan, 91, 94, 103, 106 amount spent on health care in, 201 cost containment in, 219, 237-240,

255-256, 261, 280 health care financing in, 147-151,

156, 157, 162 health care organization in, 180-181,

291 hospital reimbursement in, 255-256 physician reimbursement in, 237-24Q pragmatics of cohabitation in, 79 social responsibility in, 75 World War II and, 271

Jefferson, Thomas, 81 Johnson, Lyndon, 66, 101, 270

Kaiser Health Plan, 21, 134 Kennedy, John R, 270

Labour Party (Australia), 152, 153 Landers (Germany), 229, 252-253 Last dollar rationing, 111-112 Liberal Party (Australia), 152, 153 Liberal Party (Canada), 89 Libertarianism, 74, 84, 95, 97 Life expectancy, 9-10, 203 Literacy, 60 Local community funds, 172-173,

176-177

Mackenzie, Ian, 22 Magnetic resonance imaging (MRI),

194, 238-239, 250 Malpractice, 225 Managed care, 78, 107, 134-135, 165,

267, 268 Managed competition, 181, 189, 268 Manitoba, Canada, 232-233 Maryland, 47, 240, 246 Massachusetts, 47, 240 Maternal mortality, 9 Measles epidemic, 12 Medibank Private (Australia), 154

Index 309

Medicaid, 27, 37-38, 76, 117, 169, 175, 177, 218, 270

competition with other payers, 44, 45-46, 47, 53-54

cost-based reimbursement and, 242 cost containment and, 186, 187, 189,

191, 279-280 early opposition to, 101 eligibility for, 12, 115-116, 118-119 as entitlement, 85 financing of, 130, 137, 286 hospital reimbursement and, 242 private sector administration of,

104-105 rationing and, 108, 111

Medicalizing health problems, 56, 60 Medical underwriting, 38 Medicare (Australia), 124, 131, 153 Medicare (Canada), 23, 89-90, 91, 266 Medicare (U.S.), 27, 28, 37-38, 64, 76,

175, 179, 180, 218, 269, 270 competition with other payers, 44,

45, 47-48, 50, 51, 52, 53-54 conditions responsible for, 67 cost-based reimbursement and, 242 cost containment and, 186, 187-188,

189, 191, 210, 222, 223, 240, 256, 259, 279-280

early opposition to, 101-102 as entitlement, 86 financing of, 130, 132, 137, 140, 148,

151, 286, 287 hospital reimbursement and, 242,

243-244, 246 private sector administration of, 73-

74, 104-105 proposed cuts in, 281-282 rationing and, 112 unreasonable restrictions of, 12

Medigap insurance, 53, 180 Mental health treatment, 158-159 Ministry of Health and Welfare

Gapan), 238, 255

Ministry of Social Affairs (Netherlands), 235

Mississippi, 278 Mutuelles, 122

National Defense Education Act, 66 National Governors Association, 45 National Health Board, 212 National Health Insurance (NHI),

Japan, 150-151 National Health Service (NHS), Great

Britain, 100, 109-110, 121, 125, 165, 206-207, 266, 287; see also Great Britain

National Medical Care Act (Canada): see Medicare (Canada)

Negative income tax, 286 Neonatal intensive care, 126 Netherlands, 58, 103

amount spent on health care in, 201 competition in, 258-259 cost containment in, 215, 219-220,

234-237, 240, 241, 254-255, 258-259, 277, 280

health care financing in, 131, 143, 144-145, 146, 157

health care organization in, 171 hospital reimbursement in, 254-255 physician reimbursement in, 234-

237, 240, 241 private health insurance in, 43, 122-

123, 144, 146, 153, 258 satisfaction with system in, 204

New Deal, 65-66, 95, 101 New Democratic Party (NDP),

Canada, 89 New Jersey, 47, 52, 136, 160-161, 240 New York, 47, 240, 278

Rochester, 245, 246, 259 Nixon, Richard, 7, 21, 102, 217 Norm income, 235-237 Nursing homes, 56-57, 106

in Canada, 166

310

Nursing homes (cont.) in Netherlands, 58, 145

Office on Health Care Tariffs (Netherlands), 220

Oklahoma land grab, 81 Ontario, Canada, 88, 208, 232-233 Operating expenditures, 249, 255,

257 Oregon, 108, 111 Organization: see Health care

organization Organ transplantation, 108, 111

Painful Prescription, The (Aaron and Schwartz), 111

Palliative treatment, 121 Parallel systems, 122-125

in Australia, 122-125, 152-154, 157 in Germany; 122-123 in Great Britain, 131 in Netherlands, 122-123, 157

Participation in cost containment, 210-216, 219-221, 261, 280

Part-time employees, 37 Payroll taxes, 159

in Australia, 152, 157 in Canada, 141, 157 in France, 157 in Japan, 148, 150, 162 in Netherlands, 144, 145, 157 in United States, 130, 131, 132, 140

Pearson, Lester, 89 Per capital health care expenditures

in Canada, 168-169, 200, 201 satisfaction correlated with, 204 in United States, 4-5, 201, 202

Per diem rate of payment, 243-244, 251, 252-254

Per discharge rate of payment, 243-244, 246, 251

Persian Gulf War, 69, 271 Peterson, Peter G., 198

Index

Physician reimbursement, 131, 213-214, 227-240

competition between payers and, 45 Resource-Based Relative Value

Scales and, 213-214, 219, 220, 269 Physicians

in Australia, 124-125 autonomy of, 77-78, 104-105, 106,

223-227 in Canada, 166, 168, 208, 231-235,

239 cost containment and, 193-194,

206-207, 208, 215, 219-220, 222, 223-227, 259, 277-278

in France, 122 in Germany; 122-123, 227-231, 233,

235, 241 in Great Britain, 77, 206-207, 240,

241 historical resistance to Blue Shield,

17-19 in Japan, 237-240 managed care and, 134-135 in Netherlands, 234-237, 240, 241

Polio vaccine, 56 Practice guidelines, 77 Pragmatics of cohabitation, 78-80 P1eex· ting conditions, 12-13, 38, 40,

154 Preferred providers, 165 Pregnancy; 114, 118-119 Prenatal care, 59, 112 Preventive care, 56 Primary care physicians, 135, 213-214,

240 Prince Edward Island, Canada, 208 Private health insurance, 37-44, 117,

120-126, 280 in Australia, 43, 117, 120, 123-126,

152-154 in Canada, 120, 123 catastrophic coverage under, 145-

146

Index 311

Private health insurance (cont.) community-rating: see Community­

rating competition with other payers, 45,

47 cost containment and, 188-189 cost-shifting and, 160-163, 188 experience-rating: see Experience-

rating financing of, 132-133 in France, 117, 121-122, 123, 153,

154-155 in Germany, 43-44, 117, 122-123,

144, 146-147, 174-175, 176, 178 in Great Britain, 117, 120-121, 123,

U5-126, 153, 203 in health care organization, 287-291 income-based financing and, 160-

163, 282 in Netherlands, 43, 122-123, 144,

146, 153, 258 preexisting conditions and, 12-13,

38, 40, 54 risk assumption in, 38-40, 43 in Sweden, 117, 123, 153 in United States, 132-133 waiting periods in, 40, 154

Private sector competition with public sector, 44-

55 health care right and, 102-106 Medicare administered by, 73-74,

104-105 Privilege, health care as, 25, 113, 121 Property taxes, 132, 140-141 Prospective payment approaches, 242,

243-246, 248, 254-255 Prudential, 187 Public good approach, 42-43, 110, 111,

149-150 Public sector

competition with private sector, 44-55 health care right and, 102-106

Quebec, Canada, 87, 88, 141, 215, 233-235, 236, 277

Queuing, 251

Rationing, 13, 61, 108-113 in Canada, 194, 252 first dollar, 112 in Great Britain, 13, 108-112, 251-

252 last dollar, 111-1U

Reagan, Ronald, 74 Registered Health Funds (Australia),

125, 154 Regulatory approaches

autonomy under, 223-227 cost containment and, 197-198

Reimbursement, 291-292 health care financing distinguished

from, 130-131 See also Hospital reimbursement;

Physician reimbursement Relative fee schedules, 238 Relative value scales, 229-231, 238 Renal dialysis, 108, 109, 111, 112, 252 Resource-Based Relative Value Scale

(RBRVS), 213-214, 219, 220, 269 Retirees

in France, 154 in Japan, 150-151

Retrospective payment approaches, 242-243, 244, 246, 247, 253, 254

Rights entitlements vs., 85-86 health care as: see Health care right individual, 72-78, 84-85 selective, 71, 72

Rochester, New York, 245, 246, 259 Roosevelt, Franklin D., 66, 95, 101,

270

Salaries, 130, 131 Sales taxes, 131, 141 Sanitation, 56

312 Index

Saskatchewan, Canada, 88, 89, 208, 232-233

Scandinavia cost containment in, 209 health care financing in, 140-141,

156 private sector in, 103-104

Selective rights, 71, 72 Self-insured plans, 40, 290-291

competition with other payers, 45, 47

financing of, 132, 136-137 sickness funds (Germany)

compared with, 173 Sickness funds, 42 Sickness funds (Germany), 43, 211

consequences of leaving, 147 cost containment and, 227-229,

252-254 expenditure caps on, 44 financing of, 143-144, 286-287 in health care organization, 170,

171, 172-177 history of, 19-20 hospital reimbursement and, 252-

254 local community, 172-173, 176-177 private health insurance and, 122-

123, 146, 147 statutory, 173, 175, 176, 178 substitute, 173-174, 176-177, 178

Sickness funds (Netherlands), 43, 258 cost containment and, 235-236, 241 financing of, 144 private health insurance and, 123

Significance of the Frontier in American History (Turner), 82

Single-payer systems, 55, 102, 130, 279, 284, 293

administration costs in, 54 cost containment and, 209 criticisms of, 168 financing of, 142

Single-payer systems (cont.) resistance to, 171

Sin taxes, 131, 132, 155, 159, 281 Small businesses, 33-35, 37, 42

experience-rating and, 39, 40 health care organization and, 289 income-based financing and, 281,

282 selective rights and, 71 social responsibility and, 77

Social Insurance Agency Oapan), 148 Socialized medicine, 99-102, 203 Social responsibility, 65-72, 95

individual rights vs., 72-78 Social Security (France), 121, 154 Social Security (U.S.), 64, 66, 67, 86,

95, 270 Social Security Act (U.S.), 101 Social services, 57-60, 200, 201-202 Sooners, 81 South Africa, 61 Specialists, reimbursement of, 213-214 Starr, Paul, 17 State Medical Associations

(Germany), 229 State Sickness Fund Associations

(Germany), 229 Statutory funds, 173, 175, 176, 178 Subsidies, 139-140, 159-160, 270, 281-

282 Substance abuse, 10, 58-59, 158-159 Substitute funds, 173-174, 176-177,

178 Supplemental insurance, 121-122, 123,

131, 154-155, 179-180 Sweden, 70, 104

cost containment in, 207 health care financing in, 140-141 private health insurance in, 117,

123, 153

Taft-Hartley trusts, 132, 170, 173 Tax deductions, 155-156

Index 313

Taxes dedicated, 132, 155, 159 general: see General tax revenues income: see Income taxes income-based financing and, 162-163 in Japan, 150 negative income, 286 payroll: see Payroll taxes property, 132, 140-141 sales, 131, 141 sin, 131, 132, 155, 159, 281 subsidies and, 139 value-added, 131

Tertiary services, 112, 126, 203 Thatcher; Margaret, 125 Threshold approach, 232-233 Tobacco abuse, 59 Tower, John, 26, 194 'frauma, 126, 159 'fripartite model, 258 'fruman, Harry, 7, 101 Turner, Frederick, 81-82, 83, 92 Two-tiered systems, 157-159, 176, 179

Unbundling, 232 Unemployment, 32, 33, 37

Unemployment insurance, 68-69, 85, 95

Uniform rules, 221-222, 261-262, 291-292

Uninsured individuals, 2, 32-33, 61, 76,117, 265

Unions, 45, 47, 95, 132, 136, 151, 290-291

Utilization review, 77, 277

Value-added taxes, 131 Veterans Administration, 104, 130,

164, 175, 259 competition with other payers, 44 financing of programs, 137 reimbursement of, 246

Victim, blaming the, 67-68, 114 Vietnam War, 271 Vrrginia, 157 Volunteerism, 67 von der Schulenberg, Graf, 211, 226

Wage growth rate, 260 Waiting periods, 40, 154 Welfare, 68, 69, 70, 95 World War II, 89, 90-91, 95, 266, 271