Sammis White, Ph.D.
The health care system in the United States is not healthy. Health care costs are high and have been rising at four times the rate of inflation in recent years. Despite the high and rising costs, there are numerous problems of inappropriate and low-quality health care. And some 15% of Americans are not covered by health insurance. It is no wonder that a system consuming 14% of gross domestic product is at the top of the national agenda for change.
Numerous Wisconsin businesses struggling to compete in the international economy are also struggling with how to contain health care costs and make their workers healthier and more productive. Several companies have taken innovative steps to address these issues, steps that are in keeping with their private-market philosophies. Three of these innovative efforts are described in this report None of these efforts has been in place long enough to know for certain that it works. But all contain elements that appear to belong in a successful prescription, and early responses to them are positive.
These programs all involve “managed care;” that is, some control over access to the system. But all are trying to make the “market” work, reducing the inefficiencies caused by lack of information. Common elements included in at least two of the three are:
Partnership — of patient, provider, and payer
Fee Reductions — for both physicians and hospitals; agreements may also include other providers and pharmacies
- as a partial payer, to increase competitive choices and informed use
- as a student, to learn how, when, where, and why to access the health care system
- as a watchdog over provider charges
- as a consumer of health, practicing a healthier lifestyle
System Monitoring and Publicizing
- of prices and services
- of quality outcomes
- use gatekeepers; primary-care physicians
- reduce inefficiencies in administration and health care provision
- educate providers as well as patients, payers
Evolution — continuous change as components of the system are analyzed
Containing health care costs is an extremely complex undertaking. Controlling costs, increasing health care quality, and improving access is even more challenging. The fact that both the current proposal of President Bill Clinton and two of our models employ the use of alliances of employers to purchase health care services suggests that this is a very good place for others to start. We know few details of the Clinton proposal, but given the logic found in our three Wisconsin models, the federal plan should contain many of the same elements. Since any federal effort is likely to take years to implement and health care costs will likely continue to rise at close to recent rates, employers would be well-served to examine these three models and take their own steps to address health care issues. The results are not guaranteed, but the evidence to date is very encouraging.