Health Care Coverage and Costs: Major Legislative Proposals, Volume 4

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Page 88 - Employers would be required to pay at least 75 percent of the premium cost for employee plans, with employees responsible for the remaining 25 percent.
Page 34 - Statę, and local — with the major operating responsibility falling to the State and local jurisdictions. Each State would evaluate its health resources and capabilities and, in accordance with national guidelines, would develop a health care plan. The State plans would be submitted to the national health insurance board and, when approved, the board would contract with the State for the administration of the program within that State. Federal level A National Health Insurance Board with...
Page 35 - To finance this program, $10 million would be available for the first year of the program, $15 million for the second, and for each following year an amount equal to one-half of...
Page 35 - Rates of payment would be geared to local conditions. In deriving the rates of payment under the various methods, consideration would be given to the annual income that would accrue to practitioners. Further, reimbursement would be designed to provide incentives to practitioners to advance in their professions, pursue postgraduate studies, maintain high-quality service, allow for adequate vacation, and practice in areas where their services are needed.
Page 35 - Other Government Programs Initially, aged persons could receive those benefits of the program not provided under Medicare. The Department of Health, Education, and Welfare would be required to study the relationship between the national health insurance plan and the Medicare program and devise methods of incorporating Medicare into the national plan. Funds appropriated for Medicaid and other Federal -State assistance programs could be used by States to finance the cost of covering needy persons who...
Page 34 - A national advisory medical policy council would be established, consisting of the chairman of the national board and l6 members appointed by the Secretary of Health, Education, and Welfare. At least eight members would serve as consumer representatives and at least six as representatives of providers of medical services. The advisory council would advise the board on matters of general policy and administration...
Page 35 - Physicians and dentists could select reimbursement under various methods, including fee-for-service (based on a fee schedule), capitation (with maximum limits on the number of registered patients), full or part-time salary, or a combination of these methods. Specialists could choose the same methods and, in addition, payment on a per session or per case basis. Rates of payment would be geared to local conditions. In deriving the rates of payment under the various methods, consideration would be given...
Page 35 - ... adequacy of services where they are below the national average. The State agencies would contract with providers of care for services under the program and determine rates of payments. The payments could be administered by the State agency or the local health-service area. Nonprofit health-service insurance plans could be used as agents or intermediaries. Hospitals and other institutions would be reimbursed on the basis of reasonable costs. In calculating costs, the payment for room and board...
Page 35 - ... calculating costs, the payment for room and board would be based on the least expensive multiple-bed accommodations. A maximum rate for hospitalization could be established (after consultation with representatives of provider organizations) and it could vary according to locality and class of service. Physicians and dentists could select reimbursement under various methods, including fee-for-service (based on a fee schedule), capitation (with maximum limits on the number of registered patients),...
Page 35 - ... on the basis of population, availability of health resources and the costs of services, as indicated in the State plan. The allocation would be designed to assure that adequate health benefits are provided in all States and to improve the adequacy of services where they are below the national average. The State agencies would contract with providers of care for services under the program and determine rates of payments. The payments could be administered by the State agency or the local health-service...

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