USD Magazine, Spring 1992

because many military spouses don't need additional health insur– ance coverage, Peterson says. Hospitals are cost-cutting as well. At Green Hospital, one of the cost– controlling measures is a system fine-tuned by Peterson that regu– lates the number of nurses on duty according to the patient census and the amount of care required. The information is reviewed almost hourly and nurses are sent home if they are not needed, Peterson says. But the ultimate cost-cutter, experts say, is an informed Amer– ican public. An informed con– sumer can help reduce the more intrusive excesses of the system. Patients must be advised about the usual outcome of the procedure or medications, recommended alternatives and the differences among possible inten,entions, as well as the experiences and success level of the health provider. The trend toward preventive medicine is going to continue. There will be continued growth in the number of nurses in corpor– ations and schools. "It won't be a nurse like we had when I was in school who could give you a cup of tea and a Band– Aid," Peterson says. "It will be a nurse that goes out and teaches kids about sexual responsibility, looks in their ears, checks for hearing and vision problems." In the meantime, Fagin asks the tough questions: "Is the nation ready to make any changes in its chaotic system? " ' ill consumers at large begin to demand changes? Will our infant mortality rate begin to motivate a large segment of Americans to action? Will the

embarrassment of our uninsured begin to be felt by the American public, or will increased cost to provide universal care be rejected by Middle America?" The answers to those questions "vill determine the success - or lack of success - any proposed health-care reform might have. Without the kind of "moral outrage" those questions project, Fagin says, Americans will never vote for a plan that will cost them more money, particularly one that stresses health maintenance over an easy cure.

says. "But if it's explained to them what this test is likely to tell you and what the odds are for certain procedures, they can make the most informed, intelligent decisions." Rothman agrees that the ultimate responsibility for controlling health-care costs will eventually come down to a question of the individual taking responsibility for his or her health care. In her 1991 paper, Rothman wrote that employees can be educated to question their doctors more, chal– lenge unneeded care, ask for generic drugs or samples, avoid scheduling hospitalizations over the weekend, request admissions the morning of surgery rather than a night or two before, schedule tests before 7 p.m. and seek tests on an outpatient basis -all as a means of controlling costs. Businesses are beginning to use such cost-cutting measures as offering cafeteria plans of insur– ance. Cafeteria plans, where the employees have an option on what to purchase and can get money back if a plan is not needed, are especially popular in San Diego