The prospects for prepaid long-term care: the Arizona Medicaid experiment

Arizona is adding long-term care to its prepaid, capitated alternative to Medicaid. This article discusses the potential for this major cost-control experiment. Experience suggests that those able to quality for long-term care will fare better than the poor did in the previous system. However, limiting eligibility will be the primary means of controlling costs; significant price competition is not likely to develop. The bidding process will serve more to transfer risk to contract providers than to improve program efficiency. Potential cost savings will be more than offset by an increased identification of need.     

India's experience—national,community, public or private health?

India, as the largest democracy, second most populous country, ninth largest industrial power and fifteenth poorest nation, has in respect of health care to be considered as a special case among developing countries. Nevertheless, the identification in India, as an alternative to national welfare provision, of opportunities for returning social and economic responsibilities for health care to local communities is important for both developing and developed countries. This article outlines and comments upon recent developments in providing primary health care in rural communities in India. It concludes by examining possible parallels between self-sustaining community health schemes and the search in developed countries for community and personal involvement so as to overcome emergent limitations of professionalized and welfare systems of care.