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An Alternative Path to Universal Coverage

Bradford L. Kirkman-Liff, DrPH

JAMA. 1991;265(19):2496-2502.

Abstract
The health care systems in the Netherlands and the Federal Republic of Germany are based on a set of values that involve mutual obligations between private parties. These obligations are realized through systems incorporating private practice physicians, community and church- and municipality-affiliated hospitals, and nonprofit and for-profit insurers. The underlying values and implementation approaches in these systems provide an alternative to the adoption of a Canadian-style health insurance system. A discussion that focuses on "obligations" rather than "rights" may be a more useful approach for the design of reforms of the American health system in the 1990s. Such a discussion would focus on the mutual responsibility of all parties to create and maintain a universal private health care system.

(JAMA. 1991;265:2496-2502)

Author Affiliations
From the School of Health Administration and Policy, College of Business, Arizona State University, Tempe, and Department of Health Care Policy and Management, College of Medicine, Erasmus University Rotterdam, the Netherlands.

Footnotes
The views expressed are the author's own and not necessarily those of any of the sources of support.

Reprint requests to School of Health Administration and Policy, College of Business, Arizona State University, Tempe, AZ 85287-4506 (Dr Kirkman-Liff).

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