Consolidations and Critiques

Abstract

Two social problems of health care in the USA motivate the research summaries of the subsequent two chapters. On the one hand, many people have restricted access to appropriate care because of their lack of health insurance and spiraling costs. On the other hand, preventive vaccinations are available to children, but some parents restrict access to this care because of mistaken beliefs that vaccinations cause autism and have other adverse consequences. To address this first problem of restricted access to medical care, because of the lack of insurance and funds to cover its costs, many people advocate health insurance reforms. Regardless of what components of the Obama Administration’s comprehensive reforms are eventually instituted, the implementations will need to reduce the utilization and costs of health care appropriately. The first of these chapters bears directly on this problem. It applies meta-analytic techniques to summarize findings from evaluative studies that assessed the bounded effectiveness of precertification and onsite review nurses in reducing costs to the insurer by averting inpatient admissions and hospital care that lack evidence of medical necessity. In principle, Medicare and Medicaid plans, which are predominantly fee-for-service plans, could reconsider applying these techniques with the aim of reducing costs.