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APHA Scientific Session and Event Listing

Recorded presentation

Pauline Vaillancourt Rosenau, PhD, University of Texas School of Public Health, 1200 Herman Pressler ST, E 915, Houston 77030 TX, TX 77030, 7135009491, pauline.rosenau@uth.tmc.edu

The US health system is in crisis. Policymakers look to incremental reforms (i.e. HSAs) but incrementalism is inadequate vis-à-vis the colossal problems that are national in scope. This is unfortunate because local, community level reform would yield superior results since the US is not one, but several distinct cultures with substantial variation across regions. Successful national health system reform in the U.S. is limited by several constraints and contradictions. First, US federalism, with its dispersed authority structures, has failed to function as the Constitution anticipated in the health sector. Structural limitations make it difficult if not impossible for local health system reform experiments to succeed because of “competition to the lowest level.” Second, political paradoxes involving enormous financial resources overwhelm efforts at reform. The distinction between reform of the delivery of health services and the payment for services is eroding. Evidence-driven technology assessment is valued less in a political context where value-orientation takes precedence over rational review. Third, the historical basis for reform has been altered and now discourages change. In the end, the US health system is likely to resemble those that already exist in other industrialized countries. It would be administratively simple, include a large role for the nonprofit sector, require obligatory participation/purchase, and involve “guaranteed insure.” Pressures on the health system due to escalating global business competition increase the likely of reform. Ironically, the US based multinational business community would benefit from it in the same way as would the average taxpayer, the sick, and the poor.

Learning Objectives:

• Participants will be able to recognize the difference between incremental and comprehensive health system reform.
• The strengths and weaknesses of each will be analyzed.
• Those attending this session will have a sense of the contradictions, geographical and political, involved in community level health system reform efforts.
• They will identify the sources of these contradictions and the means necessary to address them.
• Participants will recognize the critical links between the financing and delivery of health services.

Keywords: Policy/Policy Development, Public Health Policy

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation