This article addresses legislative attempts to reverse Roe v. Wade, U.S. abortion laws vis-á-vis those of other developed nations, socioeconomic factors figuring into the decision (or option) to abort, and the positive potential impact of improved contraceptive use.
What are the health effects upon a woman who has had an abortion? In his letter to President Reagan, dated January 9, 1989, Surgeon General C. Everett Koop wrote that in order to find an answer to this question the Public Health Service would need from 10 to 100 million dollars for a comprehensive study.
With the proliferation of third party payers for health care who exercise utilization management, there has been an erosion of the physician-patient privilege and patient confidentiality. The kinds of medical information obtained by third party payers under the guise of claims administration violate the spirit if not the actual laws pertaining to physician-patient communication. It presents three episodes involving the first author in which that communication was violated by third parties administering health care benefits. Recommendations are made to protect that confidentiality in this era of increasing cost management.
Continuum of care is a vital component in providing quality health care services. True case management by physicians has been severely affected by such factors as specialization, Medicare, and generally by the extensive involvement of non-medical administrators and intermediaries in the health care system. This article expresses dissatisfaction with the present health care system and suggests a variety of changes necessary to attain a true continuum of care. These changes include the need to re-establish the concept of the primary physician; the recognition that cost containment, although important, should not be the primary driving force; and the need for public discussions and informed decision-making on health care policy and rationing.
On March 1, 1986, an innovative Medicaid program serving 96,000 recipients began operation in Philadelphia, Pennsylvania. Known as the HealthPASS program, it changed the previous fee for service Medicaid program into a capitated, managed care "gatekeeper" system. The plan was administered through a Health Insurance Organization (HIO) designed cooperatively by the Pennsylvania Department of Welfare and a for-profit health maintenance organization. In its first year, the program enrolled over 500 physician case managers, saved the Commonwealth of Pennsylvania $20 million, instituted a quality assurance program with on-site audit of primary care physician office facilities and medical records, provided a 24-hour hotline, made available central case management for mental health care, and began to compile a comprehensive database to support medical case management.
