Free Health Dissertations - Why Are Some People Healthy And Others Not? Introduction Since The Middle Of
Why are some people healthy and others not?
Introduction
Since the middle of the 1980s, health care reform has been one of the top policy initiatives of most Western industrialized states and a strong determinant, in my humble opinion, of the factors determining why some people healthy and others are not. A new wave of reform has emerged that focuses on harnessing competition to more efficiently achieve social justice ends. This paper briefly analyzes this wave of health care reform and compares two types of competition-oriented reform models, internal market reform and managed competition reform, which I feel is gleaned in Chapters 1, 2 and 4 from Evans et al (1994) and Chapter 4, Naidoo and Willis. These models are looked at in the context of their implementation in the UK, New Zealand, the US, and the Netherlands. The fundamental reason why some people are healthy and others are not can be determined by analyzing which reform model best solves the complex optimization problem of how to strike a balance between individual needs and societal interests and more generally between equity and efficiency.
Managed competition reform and internal market reform models represent an important change from the traditional approach to health care reform. This traditional approach focuses on reducing the resources available to a health care system (e.g. the hospital beds, nursing services, technology, etc.). This traditional approach assumes that physicians, when faced with restricted resources, will allocate resources optimally amongst various medical needs. By contrast, the new reform models require purchasers, government-appointed authorities, private insurers, or risk-bearing groups of health providers, to proactively manage and allocate resources amongst different health care needs (Blendon, 1990). Purchasers are expected to manage treatment decision-making by physicians and other health providers. Managed competition and internal market reform combine elements of both government planning and market approaches. Managed care, another concept that is often referred to in the context of health care reform, is the mechanism through which managed competition proposals seek to obtain cost savings, but as described further below, can be employed in any health care system.
Although increasing costs are often cited as a justification for health care reform, it is far from clear what is too much in terms of total expenditures on health services. Why are we not similarly concerned that we are spending increasing amounts on telecommunications services, cable television, computer products, or novelty toys? The concern over rising total health care expenditures is, in fact, rooted in two separate issues, concern over government spending and concern over inefficiency.
In most Organization for Economic Cooperation and Development (OECD) countries, government pays for the majority of health care expenditures.
