Managed Care - January 2008 - (Page 11) NEWS AND COMMENTARY American College of Physicians Promotes ‘Medicare for All’ Plan T he nation’s largest medical specialty association, the American College of Physicians, has endorsed single-payer national health insurance as “one pathway” to universal medical coverage. The association represents specialists in internal medicine, and afford, and that’s single-payer Medicare for all,” says Marcia Angell, MD, former editor-in-chief of the New England Journal of Medicine, and a master with the ACP, an honorary title bestowed for a distinguished career. “There is simply no way to cover everyone in a pluralistic system and control costs.” In the position paper “Achieving a High Performance Health Care System with Universal Access: What the has 124,000 members. The endorsement came after the group reviewed the health systems in 12 other countries. ACP has advocated universal coverage for Americans since 1990, and even floated its own proposal for reform, with a pluralistic perspective, in 2002. This is the first time the group has endorsed single-payer national health insurance, however. “There’s really only one choice for universal health care at a cost we can U.S.A. Can Learn from Other Countries,” published on the Annals of Internal Medicine Web site, the group says its recommendation is based on a large and growing body of evidence that the U.S. health system is performing poorly compared to nations with single-payer national health insurance. The white paper states that “Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per-capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access.” Utilization slowed by switch from copayment to coinsurance S witching from a copayment benefit design to a coinsurance benefit design slowed the growth of total permember per-month (PMPM) expenditures for all drug classes but did not have a significant effect on overall PMPM utilization, according to a study in the Journal of Managed Care Pharmacy. The research compared the drug expenditures and utilization rates in two privately-insured populations before and after a benefit design change was implemented in one of the groups. Donald G. Klepser, PhD, MBA, assistant professor at the the University of Nebraska and lead author, says the “cost sharing shifts were not that dramatic, so it didn’t price too many people out of utilization. With coinsurance, the health plan doesn’t absorb price inflation solely — both the member and insurer are affected as prices go up. “In our study, we still saw growth in utilization. It just didn’t grow so fast. This seems to be the way going forward — to give members a real share of the cost as opposed to a flat copayment.” Changes in utilization and out-of-pocket costs Intervention group Pre Per-member per-month change Number of prescriptions 1.26 Patient out-of-pocket ($) 22.76 Employer ($) 49.53 Total ($) 72.29 Post Change Percentage Pre Comparison group Post Change Percentage 1.29 24.47 52.40 76.87 0.03 1.71 2.88 4.57 2.4 7.5 5.8 6.3 1.08 20.61 40.93 61.54 1.13 21.22 46.19 67.41 0.05 0.62 5.26 5.84 4.6 3.0 12.9 9.5 Source: Klepser DG, et al. J Manag Care Pharm.2007;13(9):765–777. JANUARY 2008 / MANAGED CARE 11
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