NEWS Crisis in American health c-are

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The relatiQn between expenditUwQnme4al care and its quality:,two views 'O v{i +

Meetings on the British health service usually discuss the small percentage of the gross national product (GNP) spent on health. Meetings in the United States have the opposite concern, and 500 doctors meeting in San Francisco recently heard from economists how American expenditure on health will rise from 12% in 1989 to 14% in 1994, 18% in 2000, and (at current rates) to 100% by 2050. Expenditure on health care in the United States in 1990 will be $660 billion, a sum that is roughly equivalent to the total GNP of Britain. "Is this too much?" the meeting organised by the Palo Alto Medical Foundation was asked. "If you're a provider of health care then it seems fine" answered Uwe Reinhardt, professor of political economy at Princeton, "but if you're paying the bill then it seems too much." "But the real question," he continued "is whether we are geting value for money." And it seems that value is poor: health care is simultaneously deficient and excessive. Firstly, despite the massive expenditure on health care, about 35 million Americans (17-5% of those under 65) have no health insurance. These people usually do get care in emergencies (although Professor Reinhardt presented a case of a woman who had waited 12 hours for care after being shot in the back), but this is provided at somebody else's expense. C Thomas Smith, the president of Yale-New;Haven hospital, said that his hospital has to find $35m a year to pay for the care of those who are uninsured and to meet the difference between the costs of treating patients on Medicare and Medicaid and the amount paid by the government. It is thus not surprising that the infant mortality in the United States is higher than that in almost any western European country. Secondly, there is clear evidence of excessive, inappropriate, and inefficient care. Alain Enthoven, professor of public and private management at Stanford University, put the following evidence before the meet-

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NEWS Crisis in American health c-are -- .,.I Cl t' The relatiQn between expenditUwQnme4al care and its quality:,two views 'O v{i + Meetings on t...
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