A Plan for a Single-Payer Health Care System
The Best Health Care in the World
by
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Index
abuse. see fraud accessory health care, 69–72 administrative costs, 77 administrators, hospital, 49–51 Agency for Healthcare Research and Quality (AHRQ),16–17 AHRQ, 16–17 allowed charges, 23–24 anesthesiologists, 51–54 approval ratings. see performance criteria arbitration agreements, 44 auditing, 39–40 birth centers, 64–65 Britain, xiv budgets, 25, 76–77 bundle fees, 51–54, 57 business model. see free-market health care business plans, 1–7 Centers for Medicare and Medicaid Services (CMS), 16–17, 76 charge cards, medical, 36–39 charts. see medical records cheating. see fraud Chen, Charles H., xii–xiii, 75, 78 chronic diseases, 28, 61–62, 71– 72 citizens. see consumers CME, 33–35 CMS, 16–17, 76 coinsurance, 23–24, 31–32 collaboration, interagency, 16– 17 competition. see free-market health care complication rates, 48 consumers education of, 13–14, 19–20 feedback of, 9, 17–18, 31 medical records, 18–19, 50– 51 and NHCS policy, 27–32 primacy of, 2 relationship to doctors, 50, 78 uninsured and underinsured, 73, 75 continuing medical education (CME), 33–35 contracts hospital, 47–54 outpatient imaging services, 57–59 outpatient laboratory service, 55–56 86 A Plan for a Single-Payer Health Care System special medical clinics, 61– 62 surgical centers, 63–65 co-payments, 23–24, 29–30 corporations, 75–76 costs. see also fee schedules administrative, 77 consumer control and, 31 health care cards, 20 of NHCS, 15–16 prescription drugs, 70–71 profitability and, 6–7 courts, medical, 44–45 CPT, 21, 51–54 credit line analogy, 27–28 custodial care, 72 delivery, of services, 21–22 dental care, 71 Department of Health and Human Services, 16–17 director, of NHCS, xviii–xix, 9– 10, 15–24 disability, 71–72 division directors, 11, 15 doctors behavior, monitoring of, 35–36, 56 education of, 33–35, 59 geographical distribution of, 21 identification numbers, 10 and NHCS policy, 33–45 performance criteria, 17, 21–23 primacy of, 2 relationship to patients, 50, 78 drugs, prescription, 69–71 E&M, 37–39 economic performance criteria, 16–17 economics, 2–3, 33–34 education. see also preventative medicine of consumers, 13–14, 19–20 of doctors, 33–35, 59 efficiency, 74 employer-provided health coverage, 75–76 errors, 40–41. see also malpractice essential concepts, 1–7 evaluation & management (E&M), 37–39 FDA, 70–71 fee schedules. see also costs coinsurance, 31–32 co-payments, 29–30 hospital, 51–54 imaging services, 57 NHCS, 20–24 special medical clinics, 62 Food and Drug Administration (FDA), 70–71 fraud, xv–xvi, xvii–xviii, 12–13 free-market health care, xv–xix, 1–2, 23. see also profit funding models, ix–x, xii–xiv, 3– 4 Index 87 GDP, xiv, 15–16, 76–77 general preauthorization forms, 41–43 government insurance, 5–7, 21– 22, 30, 73–74. see also singlepayer systems gross domestic product (GDP), xiv, 15–16, 76–77 health care accessory, 69–72 essential concepts, 1–7 outcomes, 67 reform efforts, 3–4 system types, ix–x health care cards, 18–20 health care expenditures report, 15–16 health insurance. see government insurance; National Health Care System (NHCS); private insurance HMO model, 62 hospitals, xvi–xvii, 47–54 identification numbers, 10. see also health care cards insurance, malpractice, 44 insurance companies. see private insurance interagency collaboration, 16–17 Intimate Relationship, An (Chen), 75 laboratory request forms, 55–56 long-term care, 71–72 malpractice, 44–45 management, x, xvii–xviii. see also director, of NHCS; middlemen Medicaid, 16–17 medical charge cards, 36–39 medical courts, 44–45 medical doctors. see doctors medical economics, 2–3, 33–34 medical expenses, 27–28, 30, 43 medical records, 18–19, 50–51 medical tests, 35–36, 55–56, 58– 59 Medicare, xiii, 16–17, 74, 76 meetings, 25, 34 middlemen, 3, 74, 77 morals, 1–2, 71 multi-payer systems, x, 4 National Health Care System (NHCS) administration of, 15–20 defined, xix design of, 9–14 fee schedule, 20–24 models for, 76–77 National Health Service (NHS), xiv National Quality Forum (NQF), 17 National Quality Measures Clearinghouse (NQMC), 17 network, of health care participants, 20 NHI, xiii–xiv 88 A Plan for a Single-Payer Health Care System NHS, xiv NQF, 17 NQMC, 17 nurses, 50–51 obstetric delivery centers, 64–65 outpatient care, 55–56, 57–59 overutilization, 23–24, 30, 43 patents, drug, 70–71 pathologists, 51–54 patients. see consumers pay for performance, 18, 21 payment upper limits, 39–41 performance criteria hospitals, 48–49 imaging services, 57 NHCS, 7, 9, 12, 16–18 outpatient laboratory services, 55 surgical centers, 64 P4P, 18, 21 policy consumer understanding of, 19–20 setup, 12–13 politics, 73, 77 practitioners. see doctors preauthorization, 41–43 preexisting conditions, 6 prescription drugs, 69–71 preventative medicine, 13–14, 30 private insurance coinsurance and, 23–24 and free-market system, xvi– xviii vs. government insurance, 5–7, 21–22, 30, 73–74 procedure codes, 37–39 profit, 6–7, 71, 77. see also freemarket health care providers. see doctors quality. see performance criteria radiologists, 51–54 record-keeping. see tracking request forms, 58–59 rural areas, 21, 47 salaries, xvii, 53–54, 58 satisfaction. see performance criteria scores, performance. see performance criteria second parties. see middlemen self-authorization, 43 single-payer systems costs, 73–74 defined, ix–x examples of, xiii funding models, 4 management of, 7 specialized surgical centers, 63– 65 special medical clinics, 28–29, 61–62 special preauthorization forms, 41–43 surgical centers, 63–65 surgical complication rates, 48 Index 89 Taiwan National Health Insurance (NHI), xiii–xiv taxes, ix–x, 4 tests, medical, 35–36, 55–56, 58–59 time codes, 37–39 tracking consumer feedback, 31 doctor behavior, 35–36, 39– 41 health care outcomes, 67 medical expenses, 27–28, 30, 43 medical records, 18–19, 50– 51 NHCS records, 10, 18–20 uninsured and underinsured, 75 training. see education treatment, unnecessary. see unnecessary tests and treatment uninsured and underinsured, 73, 75 United Kingdom, xiv universal health care systems defined, x–xi examples of, xiii–xiv funding models, 3–4 issues regarding, 73–74 unnecessary tests and treatment, 35–36, 55–56, 58–59 upper limits, of payments, 39–41 value-based health care, xviii–xix, 7 Veterans Administration, xiii
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About the Book
Approximately fifty million people in the United States have no health insurance. Dr. Charles Chen, an obstetrician and gynecologist for almost thirty years, agrees with many people in this country that health insurance should cover every citizen, not just those who can afford to pay the rates.
A Plan for a Single Payer Health Care System takes an in-depth look at every aspect of our current health care system and provides a strategic plan, along with innovative solutions for reforming the system.
In an easy-to-understand format, Dr. Chen provides clear definitions and the pros and cons of utilizing three potential health care systems. Dr. Chen presents the results from his research on several international health care systems and then proposes the best solution for America. He recommends several concrete ideas, including establishing a Department of the National Health Care System, requesting the support of large corporations who pay high medical premiums for employees, and allowing uninsured citizens to purchase a low-cost health plan from the government.
The ability to receive medical treatment should be a basic human right. Dr. Chen's plan for improvement helps shine a bright light on a situation that has quickly become critical for this country. His plan will ultimately help ensure that all citizens have access to health insurance.
About the Author
Charles H. Chen, MD, is a fellow of the American College of Obstetricians and Gynecologists and is a board-certified obstetrician/gynecologist who has been in private practice in southern California for more than twenty-nine years. He was a chairperson of the Fountain Valley Regional Hospital OB/GYN department for four years. Dr. Chen lives in Newport Coast, California.