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The High Cost of Health Care
Policymakers agree that strategies to expand access
and control costs must proceed together. To pursue one goal without the
other is to further undermine a system already under serious stress. The
persistent and substantial increases in the costs of health care continue
to alarm economists, elected officials, business, labor, and the public.
Expenditures in the health care system are growing at a rate estimated
to exceed $1 trillion in 1995 and $1.8 trillion in the year 2000. In every
year from 1950 to 1985 except three (1973, 1978, 1984), the inflation
in national spending for health care outpaced the rest of the economy.
Put differently, in 1950 the United States spent about $1 billion per
month in health care; by 1985 it was spending more the $1 billion per
day.
When compared with other industrialized nations, the United States
spends significantly more of its gross domestic product (GDP) for health
care. Furthermore, health care costs continue to escalate to the detriment
and sacrifice of other national goals. The per capita spending for the
United States is 40 percent higher than Canada, 90 percent higher that
Germany, and 127 percent higher than Japan (figure 4). Perhaps even
more troubling is the continued increase in percentage of GDP in the
United States through 1989, when the percentages for other industrialized
countries appear to have stabilized since the early 1980's (figure 5).
The Crisis in
Physician Workforce Supply
Physician and health professional workforce
considerations are fundamental to any discussion of health care reform
strategies. The ability to provide essential health care services to all
Americans depends upon the proper supply, racial/ethnic composition, specialty
mix, and geographic distribution of physicians and other health professionals.
If a system of insurance was provided tomorrow for all Americans to ensure
access to essential health care at a reasonable societal cost, would the
right mix of physicians be available to provide quality and cost-effective
care? Furthermore, is our medical education system producing the right
mix and supply of physicians to meet our Nation's health care needs in
the 21st century? Clearly, efforts to solve the trio of inadequate access
to care, skyrocketing costs and poor relative health status would be significantly
hindered if America is also facing a crisis in physician workforce supply.
It is in this context that COGME has been examining physician workforce
supply and distribution and its impact on ensuring access to care for
all Americans. Over the past two years, the Council has focused on the
following seven major questions:
Over a two-year period since its last report, the Council received
a broad range of input. This included solicited papers covering supply
and demand for physicians, barriers to access to physician services,
and updated need-based requirements for selected specialties. The Council
limited its review of workforce assessments to the following specialties:
general/family practice, general internal medicine general pediatrics,
general surgery, obstetrics/gynecology, adult and child psychiatry,
preventive medicine, and geriatrics.
The Council received significant testimony at plenary sessions and
before its three subcommittees on Physician Manpower, Medical Education
Programs and Financing, and Minority Representation in Medicine. Representatives
from major organizations and policy-making bodies, including the major
allopathic and osteopathic hospital and medical education organizations
and major specialty organizations, have testifies on aspects leading
to this third report. Major foundations have provided testimony, including
the Josiah Mach, Jr. Foundation the Robert Wood Johnson Foundation,
the Pew Charitable Trusts, and the Kellogg Foundation. Representatives
of State and local interests, such as the New York State council on
Graduate Medical Education and the National conference of State Legislatures,
also testified. In addition, COGME reviewed the latest recommendations
from medical educators and policymakers on medical education reform
policy.
This third report to Congress and the Secretary provides the council's
principles and subsequent findings, goals, and recommendations to address
these major physician workforce issues of today. Chapter II contains
the Council's first six major findings and goals. Chapter III contains
the Council's seventh major finding and goal, which describes the major
barriers to policy change that must be addressed to attain the goals
and new directions. Chapter IV describes the Council's recommendations
for the Nation as well as specific recommendations for out Nation's
medical educators. The appendix contains projections of the total physician
supply and specialty mix if COGME's recommendations were adopted.
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