Hot Topic

An enduring feature of the health care system is continual change. Whether in the clinical or the administrative setting, change is ubiquitous. For example, health insurance benefits continue to evolve by expanding, contracting, and transforming over time.

Historical Context

Access to Care under Medicare

Across the United States, people are finding it increasingly difficult to access necessary health care. Some argue that this is evidence of a severe physician shortage, while others argue that the physician supply is adequate but poorly distributed across specialties and geographic regions. Along with the physician supply debate, the diversity of proposals for improving access to appropriate health care reveals the complexity of the problem.

The potential for health care reform in the near future makes the need for organizational research even more pressing, as reform will likely look not only at current financing structures, but also delivery system changes that will facilitate high quality, efficient, patient-centered care.¹ Policymakers will need a wide range of information to resolve a number of complex problems. They will ask who, what, where, when, and how types of questions about the current structure of our health care system and look to organizational research for answers.

The U.S. Congress recently voted to expand the scope of mental health parity laws, including the Mental Health Parity Law of 2006, to provide insured individuals with mental health benefits that are comparable to general medicine benefits. On September 18, 2007, the U.S. Senate passed the Mental Health Parity Act of 2007 (S-558), sponsored by Senator Pete Domenici (R-N.M.), which has received support from President George W.

The American public health system is financed by a complex web of federal, state, and local resources. The contributing funding streams are mostly disease or purpose driven, with dollars specifically targeted toward prevention, treatment, and control of a specific disease or purpose (e.g. diabetes or bioterrorism preparedness). However, today's most deadly diseases, including diabetes, cancer, and heart disease, result from the same behavioral and environmental risk factors and may be targeted by similar early intervention and prevention programs.

The U.S. safety net provides care to individuals regardless of their ability to pay. Because the safety net is dependent on a variety of sources of revenue-including local, state, and federal funds-state and federal policies may influence uncompensated care funding and the ability of the safety net to serve vulnerable populations.

Current Figures

Rising health care costs affect individuals, employers, providers, and payers both private and public. Unrestrained medical cost growth makes the search for new insurance products and benefit packages more pressing, yet it is difficult to accurately price these products or predict the impact on use and overall costs.  Further, understanding what constitutes affordable coverage and how to subsidize coverage for those who cannot afford market prices is also a complex undertaking.

Now that more than a year has passed since prescription drug coverage became available for Medicare beneficiaries, policymakers are examining the successes and challenges of Part D coverage.

In 2005, Americans spent approximately $2 trillion on health care services, or 16 percent of the gross domestic product (GDP), and researchers estimate that aggregate spending may exceed 20 percent by 2015.^1,2 Medicare and Medicaid expenditures alone comprise 4.6 percent of the U.S.