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National Information Center on Health Services Research and Health Care Technology (NICHSR)

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Introduction to Health Services Research : A Self-Study Course

Module 2: Brief History of Health Services Research (Page 30 of 40)

The Battle over Health Care Reform Continues

Many other groups also wanted changes in health care delivery. There was huge concern with the uninsured and under-insured populations. Many working people were not covered by their employers while workers who left one job for another could not guarantee continued coverage. For the millions with pre-existing conditions, it was tough to get new insurance (Consumer Reports, 1990; Blendon, 1992).

Access to Services in a Managed Care Environment

Representatives of the large insurance companies (like Aetna, Blue Cross and Blue Shield, and Prudential) successfully opposed universal, tax-based coverage. Organized into managed care structures, they became the champions of cost-containment by restricting members' access to specialists and supervising the extent of care offered. They and many other allies successfully championed the managed care/private insurance model and led the defeat of a single payer health plan.

Medical Journals Weigh In on Health Care Reform

The battle over health care reform featured prominently in the major mainstream medical journals like JAMA and the New England Journal of Medicine whose issues filled with articles on health care financing, patient satisfaction with medical care, and state health reform initiatives (Blendon, 1991; Fox, 1991). As Fox notes, however, such issues rarely appear in the medical school or graduate education curriculum (Fox, 1991).

Other Events

The Medicare Modernization Management Act was passed in 2003 in an attempt to provide the elderly with help in paying for prescriptions.

View Key Projects and Milestones in Health Services Research.

Discussion Questions

  1. Will the discussion of health care reform ever go away? What is your best guess as to what will happen in the next ten years surrounding health care?
  2. In a service economy, many companies say they cannot afford to pay for health care for their employees. How many people are currently under-insured or not insured at all for health care? Is there a burden on society of having large numbers of uninsured people? Has the number of uninsured increased in the past 5 years? What sources do you use to confirm the increase/decrease in the uninsured?
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