The 130th Annual Meeting of APHA

Abstract #51761

Ellen R Shaffer, PhD, UCSF, 98 Seal Rock Drive, San Francisco, CA 94121, 415-933-6204, ershaffer@earthlink.net

A national health service would function as a coordinated system to provide appropriate, continuous and integrated health services, focused on improving individual and population health. The system would be financed through a single government payer. Responsibility for delivering health care would also be transferred to the public sector. Public ownership of the system and facilities would make it possible to implement effective policies to control costs, allocate capital and services based on population need - including assurance of support for current "safety net" providers, organize the delivery system and create accountability for quality and outcomes. Supportive national policy would assure funding that is both stable and progressive. Although funding might be derived from multiple sources, a public agency would be responsible for integrating these into a single stream. Comprehensive care would be assured to all, with no requirement for individual co-payments. To assure that the system is flexible in adapting to genuine regional differences and responsive to emerging health needs, and to promote democratic participation by providers and users, administration would be delegated to the states within a framework of federal rules, guarantees, and guidelines. A focused public health system would collect data, set policies and implement targeted community interventions to improve individual and population health, including redressing inequalities. Clinicians and other health care workers would be salaried and paid by the government, which would also sponsor their education and training. Education and employment policies would work to assure an adequate size and distribution of the health workforce, to improve quality of care and to control costs. The system would rely on macroeconomic incentives for providers, tied to performance, to control costs and utilization, thus building on WHO findings that such incentives have been the most effective mechanism in Western Europe. Savings from administrative simplification and a shift in emphasis to primary care would make it possible to cover everyone for less than is spent on health care currently. Long term cost control and quality improvement are likely to require reorganization of the delivery system, entailing a shift in the relationships among clinicians, health facilities, users of health care and the government to produce improvements in health status. The system would proceed from the principle that engagement and participation by health care users and health care workers is crucial to creating a functional health care system. Engaging patients is key to keeping providers and the government accountable and responsive.

Learning Objectives:

• 3. Describe how a U.S. national health service would finance and administer universal health care.
  7. Describe how a U.S. national health service could assure an adequate and appropriately distributed health care workforce.
  11. Describe the methods a U.S. national health service could implement to control health care costs.
  15. Describe the mechanisms proposed for achieving system accountability in a U.S. national health service.
  19. Discuss the merits of a national health service as a way to achieve universal health care in the U.S.

Keywords: Health Care Reform, Universal Health Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.