The United States now spends 12.4
percent of its Gross National Product on health care. For
employers, health benefits have grown from 2.4 percent of
total compensation and 23 percent of total benefits in
1970 to 5.8 percent of total compensation and 36 percent
of benefits in 1989.
Although the effects of changes in
tax policy on national health care expenditures are
uncertain, it is clear that removing the tax preference
for employer-sponsored health insurance would reduce the
incidence of this coverage and the breadth of services it
includes.
EBRI's study of employers in the
Houston area found that plans with utilization review
(UR) had significantly lower inpatient charges but higher
outpatient charges. In a study of employers in the
Losngeles area, EBRI found that UR was associated with
lower outpatient charges and total plan charges. These
savings were achieved by decreasing total charges per
admission.
Systems have been developed to
analyze hospitals' and physicians' medical records and
measure outcomes using objective criteria that adjust for
severity of illness. Health plans that use this
information to selectively contract with providers are
beginning for the first time to directly reward providers
for low-cost, high quality health care.
Cost containment efforts have not
been uniformly adopted in local markets. One survey found
that while 79 percent of employers in the Pacific region
and 77 percent of those in the Mid-Atlantic region
offered employees a health maintenance organization
option, only 44 percent of employers in the South Central
region and 51 percent of those in the Mountain region did
so.
