title: Consumer-centered vs. job-centered health insurance.
abstract: Most employees and their dependents in the United States have health insurance provided by the employer or labor-management health and welfare fund. In this system, employees and their families lose their health insurance when the breadwinner loses his or her job while, at the same time, a Medicaid beneficiary can lose Medicaid eligibility by getting a job, even a poorly paid one. Most health insurance pays the doctor on the basis of fee-for-service and the hospital on the basis of cost-reimbursement, rewarding both with more revenue for providing more and more costly services. The insured employee has little or no incentive to seek out a less costly provider. There are no rewards for economy in this system. It should be little wonder, then, that health care costs are out of control. There are alternative financing and delivery systems with built-in incentives to use resources economically, but, the author of this article asserts, their ability to compete and attract patients with their superior economic efficiency is blocked by many laws and government programs. The author believes that the most effective and acceptable way to get costs under control, and at the same time achieve universal coverage, would be through a system of fair economic competition. He discusses his Consumer Choice Health Plan proposal and describes how one of the main barriers to competition is today's system of job-linked health insurance.
authors.forename: A C
authors.initials: AC
authors.lastname: Enthoven
mesh_terms: D003132:Commerce; D003256:Community Participation / Q000191:economics / Q000379:methods*; D003363:Cost Control; D003695:Delivery of Health Care / Q000458:organization & administration; D006264:Health Benefit Plans, Employee / Q000191:economics* / Q000331:legislation & jurisprudence; D007348:Insurance, Health / Q000191:economics* / Q000331:legislation & jurisprudence; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007750:Labor Unions; D014481:United States