Beyond Universal Health Insurance to Effective Health Care

NO ONE, least of all an economist, needs to be persuaded that people who lack money or health insurance are likely to encounter difficulties in obtaining essential health care services. On the other hand, the economist has an obligation to explain that the adoption of a system of universal coverage will not, ipso facto, translate into assured access for essential, much less optimal, health care for those who are currently disadvantaged. The reasons that universal coverage will not necessarily guarantee effective services to all are embedded in the nature and characteristics of the health care system. In developing this argument and its policy implications, we will undertake a threefold analysis, including (1) a selective review of health care financing reforms in the United States, (2) an explication of nonfinancial barriers to effective health care, and (3) a delineation of the range of interim policy interventions required to lower the barriers