Foster-Higgins (a private for profit consulting firm) released their figures for U.S. health care spending for 1995 and some of the trends they chronicle are of note, even if their data is somewhat limited in use (just tracks employer based health spending). The main concern for employers is cost and the study emphasizes that U.S. health care costs grew at 2.1% in 1995 (remember that average growth for 88-92 was around 16% and largely fed the "crisis" mentality that was behind the health care reform that never happened). The cost of HMO's shrank almost 4% and as the use of HMO's (in the broad sense) continues to grow this raises several important questions. I'd like to ignore the whole issue of whether this is a one year blip. In the past it has been difficult assessing the significance of the trends in managed care spending relative to health care generally. The general progressive line (which I largely agree with) is that HMO spending provides a "one-time" savings and that their ability to control costs is not dynamic. Technology and expanding the scope of medicine is behind the rising costs (for little life expectancy benefit) so managed care costs would rise along with the tide of "better, brighter, and more invasive machines." A little noted fact of the 1994 numbers was that managed care spending for employers grew more than the ever shrinking indemnity insurance (of course the significant different between types of insurance is shrinking even faster). ANYWAY, assuming that the 1995 numbers point to some sort of trend (i.e., managed care does control costs in a dynamic way), I would be interested in comments about what this would mean for US health policy, reforms elsewhere, implications for equitable access to health care, and implications for health. I have some ideas about this but they wander in many and varied directions so I will likely followup if anyone else has some thoghts. Jim Westrich Institute on Disability and Human Development University of Illinois at Chicago ------- "Now that the Chicago Tribune has discovered "Insurgent Country" it must be dead, we're about art-jazz country now" -- Jon(boy) Langford with the Waco Brothers Related note: Jon and the Mekons with Kathy Acker have just released "an entire CD of lesbian sea shanties.
