Combining a global health budget with a market-driven delivery system: Can it be done?

Abstract

Two correlated problems, rampant escalation of health-care costs and the lack of access to health care for many Americans, challenge long-term solutions to our health-care crisis. Historically, free markets have provided the most effective method of controlling costs. Although the current health-care system is highly competitive, it falls far short of being a truly competitive marketplace emphasizing competition around cost and quality. A health-care system based on managed competition in which the marketplace is structured to create competition on cost and quality provides great promise for regulating health costs. Erosion of health-care benefits under our current system of employer-based health insurance threatens the effectiveness of any market-based solution. The 21st Century Health Care Act combines the cost-effectiveness and universal access derived through a single revenue spigot with the power of a market approach created by managed competition.

Managed care is harmful to outpatient mental health services: A call for accountability.

“…However, to make this decision, consumers and purchasers must be informed about how managed care affects the quantity and quality of their personal mental health care. Not only is it the consumers' right to have information about the quantity and quality of their personal mental health care service, but accurate information is also essential to enable market forces to work (Bingaman, Frank, & Billy, 1993; Enthoven & Kronick, 1989). Without adequate information, consumers and purchasers cannot make an informed choice about whether a managed care program is worth the cost savings.…”

A perspective on the nation's antitrust policies: Implications for psychologists.

“…When the market includes a number of competitors, no single vendor can control prices, and the price competition among sellers lowers prices to reflect marginal cost of production. Bingaman, Frank, and Billy (1993) noted, however, that as currently constructed, "the healthcare market in the United States falls short of meeting these criteria." They further discussed the application of free market principles to health care:…”

Rehabilitation medicine, systems, and health: A biopsychosocial perspective.

“…To date, however, it is safe to say that these new healthcare macrosystems have tended to view individuals with rehabilitation needs cautiously due to the expense of long-term, comprehensive care. This is particularly problematic for individuals with chronic health conditions and/or disabilities (Bingaman, Frank, & Billy, 1993; Frank & Ross, in press).…”