Health Care For All

ACPM Position Statement 2003-085(F)

HISTORICAL PERSPECTIVE

Based on lessons learned from ACPM’s process in the early 1990s to develop a policy on health system reform, and in response to the Health Insurance for All resolution [03-02(A)] presented to the ACPM Policy Committee and the Board, a subcommittee of the Policy Committee was convened to craft a policy on health insurance reform that is reasonably cohesive and representative of the critical mass of the College membership.

WORK PRODUCT AND SCOPE

The directive from the Policy Committee was that the work product of the subcommittee be a brief position statement, with clearly articulated principles.  Such a statement will serve as the basis for ACPM leaders and experts testifying before Congress or other policy makers and for deciding whether or not to endorse other entities’ policy positions and proposals.

GENERAL PRINCIPLES

The following set of health care reform principles was developed by the subcommittee, refined by the Policy Committee, and adopted by the Board of Regents on November 16, 2003 .  The College supports health care reform measures that:

1.      Assure, for all U.S. residents, access to and payment for a federally defined and nationally implemented package of essential health services recommended through a national guidelines development process, with no denial of coverage and minimum personal co-payment. 

2.      Allow states, employers, and individuals the flexibility of supplementing the package of essential health services. 

3.      Build, where possible, on the current strengths of the American system to deliver high quality health care and prevention services, with minimal administrative and underwriting costs. 

4.      Use economic, behavior modification, and disease management tools to minimize both the over-utilization of marginally beneficial and the underutilization of demonstrably beneficial health care services.

5.      Establish state and national quality assurance and surveillance systems, which include physicians as well as financial managers, to monitor and evaluate access to care, quality of care, and medical outcomes.

DEFINITIONS, ASSUMPTIONS AND SUPPORTING COMMENTS

1.      Assure access to and payment for a package of essential health services

This principle assumes that government, both at the federal and state level, is the only entity that can assure both the payment and provision of essential health care services in the United States .  In fulfilling this assurance function, government can use existing progressive tax vehicles to provide coverage that would mitigate the regressive taxation of the current health insurance system.  “Access” is defined in this statement as the minimization of social, financial, legal and geographic barriers that impede the presentation of health services to all persons, regardless of health status.  “All U.S. residents” is defined broadly to include the whole population.  The “package of essential health services” would be defined by the federal government based on recommendations by an expert panel with broad representation, including preventive medicine and other physicians.  These services, provided through public or private programs, should include appropriate preventive, diagnostic, therapeutic, and rehabilitative services for both physical and mental health.  These should be defined by evidence-based standards constructed from systematic and explicit reviews of relevant peer-reviewed studies.  Essential health services also include evidence-based public health interventions to promote community health and prevent disease, including interventions that link people to needed health services.

2.      Allow flexibility to supplement the package of essential health services 

This principle assumes that employers and health insurance companies, even if relieved of the responsibility of providing basic health insurance, can supplement the essential health benefit package with additional benefits for the attraction and retention of employees or enrollees.  This principle also allows states the flexibility and creativity to supplement the essential health benefit package at their discretion to meet unique needs of targeted populations.  Individuals would be allowed to purchase supplemental health insurance from their essential benefit package insurer or other insurance provider.

3.      Build on the current strengths of the American system 

This principle allows for the utilization of the strengths found in American health care professionals and institutions and the insurance industry, as long as they can deliver high quality, evidence-based healthcare and preventive services with minimal administrative and underwriting costs.  Market forces would be used only for provision and management of discretionary services to control utilization and costs.

4.      Utilize tools to minimize over-utilization and underutilization of services

This principle acknowledges that there are economic and other tools that have been used by the healthcare system to control the utilization of services.  The terms over-utilization and underutilization assume that there is a targeted optimal utilization of services, which would need to be defined by the expert panel referenced in the comments on the first principle.  “Marginally beneficial services,” for example, might include those services known to be effective for some individuals in a clinical setting, but not proven to be cost effective when applied on a population basis.  There also is the assumption that none of the economic tools will unfairly inhibit access to the essential health services benefit package. Essential health services would be compensated fully with a prescribed payment schedule for professionals (RVUs) and institutions (DRGs). This principle also assumes that other, non-economic, means of addressing these issues—including behavioral counseling, health promotion, and disease and demand management—should be employed.

5.      Establish quality assurance and surveillance systems

This principle seeks to ensure that any reform of the health insurance system includes a framework and capacity for quality measurement and reporting, and support for development of quality measures that enhance and improve the ability to evaluate and improve care.  A quality assurance system should produce comparative information on health care quality that is valid, reliable, comprehensible, and widely available in the public domain. Physicians and other health professionals, not just financial managers, should be at the center of quality measurement efforts.