Contenu du sommaire : Le système de santé en question.

This article provides a brief overview of a specific aspect of managed care : Pharmacy Benefit Managers (PBMs), which are used by an increasing number of health insurers interested in controlling prescription drug costs. The article highlights their role in managing costs and providing better coordination of health services. In spite of major differences between the two systems, recently proposed health care reforms in France also aim to control costs and coordinate services. Can managed care be the solution ?

This article seeks to explore the major techniques, issues, and nascent public policy governing the practice of medically assisted procreation (MAP). On the one hand, the absence of federal regulation has encouraged the development of what some analysts call the "supermarket of procreation" , wherein only financially privileged individuals have access to new reproductive technologies. This market's value is inflated by alarmist discourses, both in popular and scientific literature, relative to supposed high rates of sterility among Americans, especially women. Meanwhile, throughout the different states, access to MAP is undergoing a certain number of restrictions. Regulations varying from state to state, for the most part emanating from the judicial system or adopted by state legislatures in accordance with judicial rulings, have a tendency to facilitate this access for married heterosexual couples with significant financial means. This has led to the political mobilization of a number of feminist, homosexual, and consumer interest groups who denounce discriminatory practices and call for unlimited access to MAP in the name of the "right to privacy" in matters of procreation as established by the Supreme Court from Griswold v. Connecticut (1965) to Planned Parenthood of Southeastern Pennsylvania v. Casey (1992).

For-profit corporations have transformed the health care delivery system with the growth of prospective payment. This paper explores the consequences of this "managed care revolution " for patients, caregivers and the public at large.

The adoption in 1990 by the Financial Accounting Standards Board of a new standard (SFAS 106) on accounting for post-retirement benefits other than pensions triggered off significant cuts in the retiree health benefits granted by many U.S. corporations to their former employees. This paper investigates the circumstances in which this new standard was issued, and used by employers for terminating some of their earlier commitments.

Even before the demise of the Clinton reform plan, some states and localities had taken the lead in expanding health insurance for their residents. The failure of the federal initiative along with exploding costs has encouraged many states to move forward with their own efforts to implement reform. Can local initiatives be an engine of change, both on the state and federal level ? These local policy innovations also raise the issue of the role of federalism in health care reform and highlight the need for a new intergovernmental partnership.