Four proposals for market-based health care system reform
W. Sumner 2nd
Department of Family Practice, Kentucky Clinic, University of Kentucky, Lexington 40536-0284.
A perfectly free, competitive medical market would not meet many social
goals, such as universal access to health care. Micromanagement of
interactions between patients and providers does not guarantee quality care
and frequently undermines that relationship, to the frustration of all
involved. Furthermore, while some North American health care plans are less
expensive than others, none have reduced the medical inflation rate to
equal the general inflation rate. Markets have always fixed uneven
inflation rates in other domains. The suggested reforms could make elective
interactions between patients and providers work more like a free market
than did any preceding system. The health and life insurance plan creates
cost-sensitive consumers, informed by a corporation with significant
research incentives and abilities. The FFEB proposal encourages
context-sensitive pricing, established by negotiation processes that weigh
labor and benefit. Publication of providers' expected outcomes further
enriches the information available to consumers and may reduce defensive
medicine incentives. A medical career ladder would ease entry and exit from
medical professions. These and complementary reforms do not specifically
cap spending yet could have a deflationary impact on elective health care
prices, while providing incentives to maintain quality. They accomplish
these ends by giving more responsibility, information, incentives, and
choice to citizens. We could provide most health care in a marketlike
environment. We can incorporate these reforms in any convenient order and
allow them to compete with alternative schemes. Our next challenge is to
design, implement, and evaluate marketlike health care systems.
