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Health-care providers are without exception excited about change in their industry. But the anticipation is mixed with apprehension.

"It's terrifying for most MDs," said Dr. Taylor Jeppson, a general practitioner in Salt Lake City. "Most physicians want security and to have some form of control. In the past, the doctor was always right and people fell in line."Jeppson believes health-care reform will force a shift in philosophy, treatment plans and the standard of living for some doctors and will emphasize general practice and prevention. Specialists may not continue to get the same financial rewards.

"We need to change the incentives and pay for prevention."

Initially, he said, doctors were "anxious. Now we're willing to band together. I'm convinced reform will come about."

The insurance industry as well is excited and nervous.

If lawmakers go with a single-payer system (see glossary) "and it's government, that would put us out of business," said Jeff Gibardi, an attorney with Gem Insurance, which specializes in insurance for small businesses.

"We're not afraid of health-care reform as long as it's not perceived to be an insurance problem," said Clark Parkinson, Gem chief executive officer. "My fear is the system will wash out the medium to small insurers. The large insurers have already positioned themselves for managed competition. We'd like to compete on more or less the same playing field."

The good news, according to Gibardi, is everyone has been invited to participate in Utah's health-care reform process. "We're partners in it."

Small-business employers - the backbone of Utah's economy - fear they won't be able to support the burden if they are required to provide insurance. And employers who are self-insured don't want the government changing insurance programs they say work well for them.

The E.A. Miller meat processing plant in Cache County, with 1,200 employees, has innovative cost-containment features in its insurance. For instance, anyone who is injured on a motorcycle while not wearing a helmet is not insured. Same with seat belts. Smokers pay a higher insurance premium but are given the opportunity to attend smoke-cessation classes and get prescription nicotine patches, according to Eric Falk, human resources manager.

People are even divided on how much change reform should make.

"My worry is the tendency for some to suggest incremental or token kinds of fixing the system," said Rick Kinnersley, president of the Utah Hospital Association, a trade group and advocate for 54 member health providers in Utah. "Any reform, to be meaningful and have a chance of success, has to be comprehensive. We have to change the underlying incentives and the way we deliver health care. If we fail to do that, the only alternative is a highly regulated, government-administered system that ultimately results in rationing and heavy limitations."

"I'm concerned that we build upon the strengths that exist in the health-care system," said Steven Kohlert, Intermountain Health Care senior vice president. "Utah compares favorably with other states (in terms of health-care cost, hospital utilization and other measures). There clearly are some right things happening. We need to capitalize and build on those. If I have a fear, it's that we won't do anything. It's so complex we might throw up our hands and walk away. We can't afford to do that."

"We're afraid the debate is going to be so complicated that the typical people - who will be affected - won't understand it," said Bill Crim, Utah Issues, who is an advocate for poor people.

The worst case, he said, would be a plan that sets up a class system, with bare-bones coverage for poor people and richer policies for those who can afford them.

There's so much concern among health-care providers that many have banded together as the Utah Alliance to prepare their own reform proposal. Members expect to present details of their plan to the commission on Aug. 3.

They're not the only ones with health-reform plans and concerns. FHP, The American Association of Retired Persons, the American Nursing Association, medical groups, the Heritage Foundation, several previous health-care task forces and some political-action groups each have come up with health-reform plans. So have insurance companies and business coalitions.

In the meantime, Crim's conflicting fears are shared by others:

That nothing will happen.

Or something bad will happen.



A beginner's guide to Health-reform language

All-payer system: A regulatory system that sets the price all purchasers must pay for health care services. The rates and policies for a uniform payment system.

Capitation: A way to pay for health services in which an individual or insitutional provider is paid a fixed amount for each person served, regardless of how much service is used. Such a system encourages providers to keep costs down.

Community rating: A method of calculation health plan premiums using the average cost of actual or anticipated health service services for all subscribers within a specific geographic area. The premium does not vary for groups or subgroups of subscribers on the basis of their specific claim experiences.

Co-payments: The payments made by an individual at the time he or she uses health care services.

Cost shifting: When health-care providers are not fully reimbursed for care, charges to those who pay must be increased.

Global budget: A state or group would have so much health-care money and would have to provide all health-care services withing that limit.

Individual mandate: Each individual would be responsible for buying inot healt-care coverage. Employers would be encouraged to continue to offer insurance but would not have to.

Managed care: Any king of plan that uses selective contracting to channel patients to a limited number of providers and that requires review to control unnecessary use of health services. It also influences utilization of services, their costs and measures performance.

Managed competition: Networks of health care providers competing on the basis of price and quality. In this system, clinets would choose a network and receive all of their health care through it.

Single-payer plan: One entity pays all health-care providers. In Utah, it likely would not be the government, but bids would be based on how low bidders could keep administrative costs.

Traditional care: Doctors and hospitals of Patient's choice, without case management.