Alternative Health Care Delivery and Financing Systems Conference, Baltimore, MD. November 16-19, 1987.


The participants at the conference examined alternative health care delivery systems and/or financing arrangements from the private sector including managed care (HMO) association representatives, health care market analysts, health economists and public health academicians. The overall issues considered included: 1) what would be the level of private industry participation and response to Federal procurement of alternative delivery health care and financing systems; 2) what are the specific organizational settings, options, promises and pitfalls of alternative health care delivery and financing systems; 3) what are the special health care characteristics and requirements particular to American Indians and Alaska Natives (AI/ANs); and 4) what are future trends in the development of alternative health care and finance systems. Several themes emerged as consensus points including: 1) tribes must play the key role in the development and management of their own alternative health care systems; 2) both informational and educational communication links between the Tribes and the central policy makers must be established and kept open; 3) local decisions must be incorporated into central policy decisions; 4) overall mission of elevating the health status of AI/ANs must not be compromised; 5) alternative health care delivery systems and alternative financing arrangement are conceptually related but should be considered separately; 6) working with managed care systems, the real challenge will be to achieve balance between the dual objectives of cost containment and quality of care; and 7) the issue of risk management and risk sharing will require further and extensive investigation by both financial and policy analysts. The general sense of conference participants was that these deliberations marked the beginning of an analytical process that should be given sufficient time to nurture. Across a wide spectrum ranging from technical expertise to attitudinal reactions, more input is needed and will be sought.