healthcare financing article.pdf

36 goodman et al 10 37 aaron and schwartz 102 38 ibid

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36 Goodman, et al., 10. 37 Aaron and Schwartz, 102. 38 Ibid., 119, regarding how British physicians rationalized their part in limiting treatment by gradually redefining standards of care, and telling selective patients that “nothing can be done” instead of telling them that the option was there, but would be politically difficult to access. 39 This writer has talked extensively with physicians from Romania who worked before the Revolution in 1989. Care for patients was officially “free” but with rationed resources, an oversupply of patients, and extremely low wages for physicians, it was the cultural norm for the patient to pay the physicians with “gifts”. Christian physicians were conflicted, desperately needing the money to support their families. Some compromised by accepting payments from those who were better off than they were, but not from those who were poorer. 40 Goodman, et al., 9-10. 41 Ibid., 34. See also Aaron and Schwartz, 87.
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© 2008 Leah M. Willson, MD, MA 22 42 Aaron and Schwartz, 23. 43 Some authors refer to this phenomenon as “job lock”. 44 Newhouse, 351. The RAND experiment contains some intriguing but limited data on the cost effectiveness of targeted benefits. 45 For example, persons with PKU are generally uninsurable because they require a very expensive phenylalanine- free formula to meet their dietary protein needs. As long as they have this formula and adhere to their diet, they are otherwise healthy (without the formula, they develop mental retardation and seizures). If they had a disability- specific benefit for their formula, they should be privately insurable under a community rating. There would be no incentive for fraudulent claims—the diagnosis is made by state screening programs, and the foul-tasting formula is not good for anything else. 46 Aaron and Schwartz, 133. 47 Ibid., 10. 48 There is a much lower percentage of specialists in those countries with national healthcare in comparison to the US-- even what we would consider primary care specialists such as pediatricians, obstetrician-gynecologists, and internists. 49 Brock and Daniels. 50 Brock and Daniels. 51 See Aaron and Schwartz, 116, for discussion of “visibility of illness” and “advocacy” in relation to rationing. 52 Andy Humm, Gay City News 03/29/2007 “ACT UP Roars Again at 20” accessed 9/5/07 at 53 Estimates are that 80% of fetuses diagnosed prenatally with Down Syndrome are aborted. Statistics for fetuses diagnosed with heart defects and cleft palate are similar. 54 Thomasma, “The Ethics of Managed Care”, 244. 55 Stephen Bertram, “State Children’s Health Insurance Program Reauthorization”, 824. 56 All children’s hospitals treat many patients without reimbursement or with reimbursements below cost, with help from private charitable contributions. Some treat all patients free of charge: St. Jude’s treats children with cancer, and the Shriner Hospitals give care to children with burns, orthopedic injuries, and orthopedic disabilities.
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