|
NOTE: The UMA House of Delegates referred the following report and
recommendations to the Board of Trustees for decision. The UMA Board
adopted the Position Statement at its meeting in November 2006, but continues to solicit comments from UMA members regarding
this policy.
You may send your comments via email to reform{at}utahmed.org (replace {at}
with @ symbol) or via fax to (801) 747-3501 or send them via snail mail to
the UMA office.
Position Statement from
the Statewide Healthcare Task Force
This position paper was developed in response to
two resolutions from the UMA House of Delegates.
2004 UMA House of Delegates Resolution 6:
Statewide Healthcare Task Force
RESOLVED, That the UMA create a task force to
develop a policy statement on coverage for the uninsured and underinsured.
2005 UMA House of Delegates Resolution 7:
Statewide Healthcare Task Force
RESOLVED, That the Utah Medical Association
instruct its Statewide Healthcare Task Force to meet on a monthly basis with the
intention that it provide a progress report in the April 2006 UMA Bulletin as
well as a report to the 2006 House of Delegates on its charge from the 2004
House of Delegates to develop a policy statement on coverage for the uninsured
and underinsured.
Guiding Statement
The Utah Medical
Association believes that all people in Utah must have equitable access to
needed healthcare that is affordable and of high quality.
Background
Access to healthcare is a
national and state crisis. Nationally, as many as 85 million persons are without
any form of health coverage and this number has been growing annually. In Utah,
more than 300,000 persons are uninsured and at least as many more are
underinsured.
Many professional
organizations, government entities, states and advocacy groups have called for
reform of the healthcare system to address access for the uninsured. No
comprehensive system of reform has yet been implemented to resolve this issue.
The employer-sponsored
health coverage system is on the verge of failure. Coverage is offered to fewer
and fewer individuals while those with insurance must pay a greater and greater
percentage of the cost of their care. The problem of access will continue to
expand without a complete overhaul of the healthcare delivery system. Attempts
to make limited alterations to the current system cannot solve the problem.
Healthcare obtained by
those without coverage is frequently in the emergency department setting in a
hospital. When the patient cannot afford to pay for these services, the cost is
ultimately absorbed by society in the form of higher charges for services to
individuals covered by private or public payers. In many places in the nation,
hospitals have closed or eliminated emergency room services due to inability to
recoup costs of caring for the uninsured—further reducing access to healthcare.
This system of “coverage” for the uninsured is expensive, inefficient, and does
not fairly distribute the expense of this healthcare. This task force recognizes
that there are many challenges that are interrelated and must be solved that are
outside of the scope of this task force (i.e. electronic health records, tort
reform, regulatory relief, improving medical safety, etc.)
Guiding
Principles
The UMA Healthcare Task
Force believes that any proposed solution to the healthcare access crisis must
embrace several key guiding principles. We advocate universal access to needed
healthcare for all Utahns and a system which treats all Utahns equitably. Utah
should adopt comprehensive reform of its healthcare coverage system which:
1.
Equitably provides a basic package
of needed healthcare to all who live in Utah.
a.
“Needed” means any healthcare
interventions necessary to prolong life or relieve suffering.
i.
The precise package of services
provided to all Utahns must be specifically defined as part of the reform
process. This package must be compatible with our societal values and
resources. Services should be evidence-based, cost-effective and include acute
care, chronic disease management, preventive and catastrophic care.
b.
“Healthcare” is broader than
medical care, and includes disease prevention, public health interventions,
mental health care, and dental care.
c.
“Provides” means that all persons
have access to these services, without barriers due to financial status,
culture, language or geography
d.
“All” includes citizens and
non-citizens living in Utah regardless of health history.
e.
“Equitable” refers to being just,
fair, and impartial and means that services are comparable in scope, quality,
affordability and availability regardless of the geographic or social status of
the individual.
2.
The basic healthcare package
should:
a.
Provide a mandate for all persons
to participate in their healthcare choices and to bear a portion of their
healthcare expenses requisite with their resources.
b.
Allow all Utahns to choose their
desired healthcare provider.
c.
Provide incentives for healthy
living and responsible utilization of health services.
d.
Promote obtaining high quality
primary and preventive health care.
e.
Be completely portable.
f.
Be continuous and not result in
lapsed coverage due to changes in income, employment, age or marital status.
g.
Fairly distribute the cost of care
for all Utahns.
i.
The cost of obtaining healthcare
for individuals should be similar regardless of payor and the expense to
individuals should be requisite to his or her resources.
ii.
All stakeholders, government,
private, non-profit, not-for-profit and for-profit; insurers, government,
hospitals, physicians and all citizens should share in the burden of care for
the medically underserved. In order to maximize the benefits of risk sharing, no
single entity should carve out the healthiest or lowest-risk patients from the
risk pool.
iii.
The system must strive to find the
balance between maximizing which maximizes quality, and access and quality and
minimizes cost. The system should encourage evidence-based care, innovation and
technology which improves outcomes and lowers cost.
h.
Maintain a high quality pool of
medical caregivers. The medical system must be one that attracts the best
students to medicine and motivates high quality, efficient, compassionate
doctors to remain working in their profession and in their chosen work setting.
i.
This includes solving our medical
tort crisis.
ii.
Legislative and governmental licensure/laws should support excellence in
health care provider training rather than supporting minimal standards.
i.
Provide timely care.
j.
Promote efficiency and minimize
administrative costs.
3.
The basic healthcare package would
be universal and mandatory. Additional coverage for healthcare beyond the basic
package could then be purchased by groups, individuals, employers or others in a
competitive marketplace. Necessary
legislation must respect the professional doctor/patient relationship and
minimize interference.
4. The basic healthcare package will be
determined by a committee. The Members of the committee will be appointed as
defined by law and will include citizens that represent the complete community
dynamics, including but not limited to, patients, providers and payers and will
be staffed by experts in healthcare.
Framework for
Healthcare Reform
The UMA Task Force does not
advocate a specific model for healthcare reform, but believes that all
stakeholders in the state’s healthcare system should partner to create a
pragmatic, achievable reform package which embodies the principles listed above.
The Task Force has made
observations in several areas that may contribute to creation of a workable
structure for healthcare reform.
1.
The concept of insurance is an
insufficient basis for comprehensive healthcare reform.
a.
The insurance model alone cannot
address needed reform to the healthcare system. Insurance operates on the
principle of cost diffusion through shared risk; many people pay a relatively
small amount of money which then pays for expensive services ultimately used by
only a small number of these people. While the concept of shared risk is useful
when dealing with relatively unusual diseases or catastrophic care, it cannot
function to cover primary and preventive care, care that is needed by everyone.
Nor is shared risk an adequate means to provide for the management of common
chronic diseases that will affect most people.
b.
Inadequate healthcare funding
provides a perverse incentive for patients to avoid preventive and primary care.
It is prudent to prevent illness and treat disease early. Health coverage
should encourage, not discourage such care.
2.
Since all persons require
healthcare during the course of their lives, the cost of the healthcare system
should be shared throughout society.
a.
No entity should have the luxury
of profiting from the healthcare system through selecting only affluent or
low-risk individuals to form a payment pool. Participants in the system must
participate through the spectrum of population.
b.
The cost of healthcare for those
in the lowest income levels must be shared by all in the system: insurers,
government, medical providers, hospitals, non-hospital health centers, charitable
organizations. No single entity should bear a disproportionate amount of this
burden. Cost should be requisite to the individual’s ability to pay.
c.
When government programs and tax
structure are used to support the healthcare system, this support should be
distributed equitably and progressively for individuals.
d.
Government support or tax benefits
should not be structured to favor specific segments of the healthcare industry over
others.
3.
The uninsured
and underinsured
are not a static group.
a.
Many uninsured persons transition
to and from this status based on employment changes, status as students, marital
status, age, financial circumstances and other reasons.
b.
A comprehensive solution must
provide a means for ongoing coverage despite these life changes. Episodic
coverage leads to fragmented health care which results in greater long-term
healthcare expenses due to lack of early care.
c.
The practice of denying coverage
for pre-existing medical conditions is counterproductive and must be eliminated.
4.
Healthcare is more effective when
patients have some financial responsibility for the cost of the care they
obtain.
a.
Services of uncertain utility are
often obtained when insurance coverage is assured and the patient is shielded
from the expense. Rather than fixed annual deductibles, a system of shared
cost should be utilized for all services, allowing the patient to participate in
the decision-making regarding their value and need. This system of shared cost
should be equitable, adjusted to the means of the individual.
b.
Primary and preventive care should
come at very little cost to the individual who should be strongly encouraged or
given incentives to make good use of such services.
c.
Costs, quality measures, and
reimbursement should be transparent, empowering patients to make decisions based
on cost, risks, benefits, and quality.
d.
The cost of healthcare to the
purchaser should be similar whether purchased privately or publicly,
individually or as a group.
e.
The cost of healthcare for those
in the lowest income levels must be equitably shared by all in the system.
5.
Healthcare is less expensive when
patients make healthy lifestyle choices. There should be an incentive for
healthy living.
a.
While many aspects of disease are
not under the direct control of an individual, behaviors known to promote good
health should be given incentives.
b.
Societal entities which promote
behaviors which increase disease burden should be required to make extra
financial contributions to the healthcare system.
6.
The best solutions are simple.
a.
Complicated structures and
regulations, complex utilization of the tax code, and limitations on provider
choice all act as barriers to access for lower income persons.
b.
The tax benefits must go to the
person or group that pays the premium.
7.
Coverage must be mandatory. The
basic benefit package must include cost-sharing components and must be required
for all Utahns.
8. The healthcare system should benefit all.
Everyone should bear some financial responsibility for the healthcare system.
References
1. Goodman, J., Musgrave, G., and Herrick,
D. Lives at Risk, Rowman & Littlefield Publishers, Inc., 2004.
2. Farley, T., and Cohen, D.
Prescription for a Healthy Nation, Beacon Press, 2005.
3. Scandlen, G. “Rethinking the
Uninsured,” Galen Institute, 2004.
4. Institute of Medicine Report on the
Uninsured, “Insuring America’s Health: Principles and Recommendations,” January,
2004.
5. Brown, L. “Comparing Health Systems in
Four Countries: Lessons for the United States,” American Journal of Public
Health. 2003; 93:52-55.
6. Polikowski, M., Santos-Eggimann, B.
“How Comprehensive are the Basic Packages of Health Services? An International
Comparison of Six Health Insurance Systems.” Journal of Health Services
Research & Policy 7 (3), 2002: 133-142.
7. Institute of Medicine. Uninsurance
Facts and Figures, 2004.
8. Sheils, J., and Haught, R. “Cost and
Coverage Analysis of Ten Proposals to Expand Health Insurance Coverage”
Covering America: Real Remedies for the Uninsured.” October, 2003, the Lewin
Group.
9. Citizen’s Health Care Working Group:
“Health Care That Works for all Americans.” Interim recommendations. June 1,
2006.
Recommendations from the
UMA Statewide Healthcare Task Force for Further Action
A. The Task Force recommends that the
House of Delegates formally adopt the Utah Medical Association’s Statewide
Healthcare Task Force Position Statement.
B. The Task Force recommends that UMA
support the findings of the Citizens’ Heath Care Working
Group. The complete document will be attached as an addendum at the end of
the UMA Position Statement from the Statewide Healthcare Task Force.
C. The Task Force recommends that the UMA
develop a coalition with all other groups which are formulating plans for
covering the uninsured. The goal will be to work with the legislature to develop
a strategy for implementation that allows access to care for all Utahns in
agreement with the Guiding Principles in the UMA Position Statement.
Funding Options
The Task Force discussed
evaluating funding options for healthcare coverage reform but decided that the
funding issue was beyond the scope of its assignment.
| 
Back to
UMA Home Page