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Brustein JA, Ponzio DY, Duque AF, Skibicki HE, Tjoumakaris FP, Orozco FR, Post ZD, Ong AC. Cost Disclosure of Surgeon "Scorecards": Effects on Operating Room Costs for Total Hip and Knee Arthroplasty. HSS J 2022; 18:527-534. [PMID: 36263272 PMCID: PMC9527537 DOI: 10.1177/15563316211061510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/17/2021] [Indexed: 02/07/2023]
Abstract
Background: Rising health care costs, coupled with an emphasis on cost containment, continue to gain importance. Surgeon cost scorecards developed to track case-based expenditures can help surgeons compare themselves with their peers and identify areas of potential quality improvement. Purpose: We sought to investigate what effect surgeon scorecards had on operating room (OR) costs in orthopedic surgery. Methods: Our hospital distributed OR cost scorecards to 4 adult reconstruction fellowship-trained orthopedic surgeons beginning in 2012. The average direct per-case supply cost of procedures was calculated quarterly and collected over a 5-year period, and each surgeon's data were compared with that of their peers. All 4 surgeons were made aware of the costs of other surgeons at the 2-year mark. The initial 2 years of data was compared with that of the final 2 years. Results: The average direct per-case supply cost ranged from $4955 to $5271 for total knee arthroplasty (TKA) and $5469 to $5898 for total hip arthroplasty (THA) during the initial 2-year period. After implementing disclosures, the costs for TKA and THA, respectively, ranged from $4266 to $4515 (14% annual cost savings) and from $5073 to $5727 (5% annual cost savings); 3 of the 4 surgeons said that cost transparency altered their practice. Conclusion: Our comparison suggests that orthopedic surgeons' participation in a program of operative cost disclosure may be useful to them; we found a possible association with reduced per-case costs for TKA and THA at our institution over a 5-year period. More rigorous study that incorporates the effects of the scorecards on patient outcomes is warranted.
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Affiliation(s)
| | | | | | - Hope E. Skibicki
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | | | | | | | - Alvin C. Ong
- Rothman Orthopaedic Institute, Egg Harbor Township, NJ, USA
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Dall'Oglio I, Nicolò R, Di Ciommo V, Bianchi N, Ciliento G, Gawronski O, Pomponi M, Roberti M, Tiozzo E, Raponi M. A systematic review of hospital foodservice patient satisfaction studies. J Acad Nutr Diet 2015; 115:567-84. [PMID: 25634093 DOI: 10.1016/j.jand.2014.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
Abstract
The quality of hospital foodservice is one of the most relevant items of health care quality perceived by patients and by their families. Patient satisfaction is considered a way of measuring the quality of services provided. The purpose of this study was to retrieve and review the literature describing patient satisfaction with hospital foodservices. The systematic review was conducted on three electronic archives, PubMed, Excerpta Medica Database, and the Cumulative Index to Nursing and Allied Health Literature (1988 through 2012), to search for any articles reporting patient satisfaction with hospital foodservices. A total of 319 studies were identified. After removing duplicates, 149 abstracts were reviewed, particular attention being given to the presence of a description of the tool used. Thirty-one articles were selected and the full texts were reviewed. Half the studies (n=15) were performed in North America. Patient satisfaction scores were generally high, with some variation among hospitals and different modes of food delivery that was investigated through intervention studies. Qualitative studies were also reported (ethnographic-anthropologic methods with interviews and focus groups). Quantitative tools were represented by questionnaires, some of which relied on previous literature and only a few were validated with factorial analysis and/or Cronbach's α for internal consistency. Most analyses were conducted assuming a parametric distribution of results, an issue not primarily tested. More studies on the quality of hospital foodservice have been carried out in North America than in Europe. Also, a variety of tools, most of which have not been validated, have been used by the different investigating facilities.
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Aggarwal A, Sullivan R. Affordability of cancer care in the United Kingdom – Is it time to introduce user charges? J Cancer Policy 2014. [DOI: 10.1016/j.jcpo.2013.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
OBJECTIVE To develop and test the psychometric properties of the EMPATHIC-N (EMpowerment of PArents in THe Intensive Care-Neonatology) questionnaire measuring parent satisfaction. DESIGN A psychometric study testing the reliability and validity of a parent satisfaction questionnaire by applying confirmatory factor analysis including standardized factor loadings and subsequently Cronbach's α reliability estimates across time, congruent validity, and nondifferential validity testing. SETTING A 30-bed neonatal intensive care unit in a university hospital. PATIENTS Two cohorts with a total of 441 parents whose child was admitted to the neonatal intensive care unit, January to December 2009. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In the first cohort, 220 of 339 (65%) parents responded; in the second cohort, 59 of 102 (58%) parents responded. Structural equation modeling and confirmatory factor analysis resulted in a sufficient model fit of 57 statements within five domains: Information, Care & Treatment, Organization, Parental Participation, and Professional Attitude. Standardized factor loading of these statements were between 0.58 and 0.91. Reliability measures, Cronbach's α, of the domains ranged from 0.82 to 0.95. Reliability across time showed no evidence of statistically significant differences between the domains. Congruent validity was confirmed by a good correlation (p = .01) between the domains and four general satisfaction questions. Nondifferential validity showed no significant effect sizes between the infants' characteristics and the domains, except between ventilated infants and parent participation statements and infants ≥30 wks gestational age and organizational statements. CONCLUSIONS The EMPATHIC-N questionnaire is a valid quality performance indicator to measure the delivered care as perceived by parents.
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Abstract
BACKGROUND A variety of reforms to traditional approaches to provider payment and benefit design are being implemented in the United States. There is increasing interest in applying these financial incentives to orthopaedics, although it is unclear whether and to what extent they have been implemented and whether they increase quality or reduce costs. QUESTIONS/PURPOSES We reviewed and discussed physician- and patient-oriented financial incentives being implemented in orthopaedics, key challenges, and prerequisites to payment reform and value-driven payment policy in orthopaedics. METHODS We searched the MEDLINE database using as search terms various provider payment and consumer incentive models. We retrieved a total of 169 articles; none of these studies met the inclusion criteria. For incentive models known to the authors to be in use in orthopaedics but for which no peer-reviewed literature was found, we searched Google for further information. RESULTS Provider financial incentives reviewed include payments for reporting, performance, and patient safety and episode payment. Patient incentives include tiered networks, value-based benefit design, reference pricing, and value-based purchasing. Reform of financial incentives for orthopaedic surgery is challenged by (1) lack of a payment/incentive model that has demonstrated reductions in cost trends and (2) the complex interrelation of current pay schemes in today's fragmented environment. Prerequisites to reform include (1) a reliable and complete data infrastructure; (2) new business structures to support cost sharing; and (3) a retooling of patient expectations. CONCLUSIONS There is insufficient literature reporting the effects of various financial incentive models under implementation in orthopaedics to know whether they increase quality or reduce costs. National concerns about cost will continue to drive experimentation, and all anticipated innovations will require improved collaboration and data collection and reporting.
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Affiliation(s)
- David Lansky
- Pacific Business Group on Health, San Francisco, CA USA
| | | | - Kevin J. Bozic
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus, MU 320W, San Francisco, CA 94143-0728 USA ,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA USA
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Construction and psychometric testing of the EMPATHIC questionnaire measuring parent satisfaction in the pediatric intensive care unit. Intensive Care Med 2010; 37:310-8. [PMID: 20848078 PMCID: PMC3028088 DOI: 10.1007/s00134-010-2042-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 07/26/2010] [Indexed: 11/25/2022]
Abstract
Purpose To construct and test the reliability and validity of the EMpowerment of PArents in THe Intensive Care (EMPATHIC) questionnaire measuring parent satisfaction in the pediatric intensive care unit (PICU). Methods Structured development and psychometric testing of a parent satisfaction-with-care instrument with the results of two cohorts of parents (n = 2,046) from eight PICUs in the Netherlands. Results In the first cohort, 667/1,055 (63%) parents participated followed by 551/991 (56%) parents in the second cohort. The empirical structure of the instrument was established by confirmatory factor analysis with the first sample of parents confirming 65 statements within five theoretically conceptualized domains: information, care and cure, organization, parental participation, and professional attitude. The standardized factor loadings were greater than 0.40 in 63 statements. Cronbach’s α, a measure of reliability, per domain ranged from 0.73 to 0.93 in both cohorts with no significant difference documenting the reliability over time. Beside rigorous content and face validity, the congruent validity of the instrument showed adequate correlation with four gold standard questions measuring overall satisfaction. The non-differential validity was confirmed with no significant differences between the population characteristics and the domains, except that parents with a child for a surgical admission were more satisfied on information issues. Conclusions The final EMPATHIC questionnaire incorporates 65 statements. The empirical structure of the satisfaction statements and domains was satisfactory. The reliability and validity proved to be adequate. The EMPATHIC questionnaire is a valid quality performance indicator to measure quality of care as perceived by parents.
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Krahn G, Fox MH, Campbell VA, Ramon I, Jesien G. Developing a Health Surveillance System for People With Intellectual Disabilities in the United States. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2010. [DOI: 10.1111/j.1741-1130.2010.00260.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schumacher JR, Smith MA, Liou JI, Pandhi N. Insurance disruption due to spousal Medicare transitions: implications for access to care and health care utilization for women approaching age 65. Health Serv Res 2009; 44:946-64. [PMID: 19292774 DOI: 10.1111/j.1475-6773.2009.00952.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess whether a husband's Medicare transition leads to insurance disruptions for his wife that impact her perceived access to care, health care utilization, or health status. DATA SOURCES/STUDY SETTING Respondents were married women under age 65 from the 2003-2005 round of the Wisconsin Longitudinal Study (N=655). STUDY DESIGN Instrumental variable (IV) linear and IV-probit analyses provided unbiased estimates of the effect of an insurance disruption on study outcomes. The instrument was the husband's age: (1) women with husbands who transitioned to Medicare within the previous year (age 65-66); (2) women with husbands who did not transition (60<age<65). DATA COLLECTION/EXTRACTION METHODS Respondents were surveyed via telephone and mail. PRINCIPAL FINDINGS After adjustment, women who experienced an insurance disruption due to their husband's Medicare transition had a greater probability of experiencing a change in usual clinic/provider (71 percent), delaying filling or taking fewer medications than prescribed because of cost (75 percent), going to the emergency room (52 percent), and had lower average mental health scores than women who did not experience an insurance disruption. CONCLUSIONS Despite consistent insurance coverage, the insurance disruption that accompanies a spouse's Medicare transition has adverse access and health care utilization consequences for women.
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Affiliation(s)
- Jessica R Schumacher
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53726, USA.
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Hibbard JH. Using Systematic Measurement to Target Consumer Activation Strategies. Med Care Res Rev 2009; 66:9S-27S. [DOI: 10.1177/1077558708326969] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Current policy directions place high expectations on consumers, pressing them to adopt new roles and behaviors. The price of failing to meet these expectations will be high for the individual, for the care delivery system, and for the society as a whole. Yet there is limited support in place to help consumers meet these expectations. The article reviews the major approaches used to stimulate consumer engagement in health and health care. The concept of activation is explored as a possible organizing construct for informing strategies to increase consumer involvement in health. Illustrative data are presented that show how activation levels are associated with engaging in specific health behaviors. The strategy of measuring activation and calibrating both the type and the amount of support for consumers is discussed as a way to improve current approaches. Tailoring activation to the individual, group, and community level is also explored.
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Hussey PS, de Vries H, Romley J, Wang MC, Chen SS, Shekelle PG, McGlynn EA. A systematic review of health care efficiency measures. Health Serv Res 2009; 44:784-805. [PMID: 19187184 DOI: 10.1111/j.1475-6773.2008.00942.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To review and characterize existing health care efficiency measures in order to facilitate a common understanding about the adequacy of these methods. DATA SOURCES Review of the MedLine and EconLit databases for articles published from 1990 to 2008, as well as search of the "gray" literature for additional measures developed by private organizations. STUDY DESIGN We performed a systematic review for existing efficiency measures. We classified the efficiency measures by perspective, outputs, inputs, methods used, and reporting of scientific soundness. PRINCIPAL FINDINGS We identified 265 measures in the peer-reviewed literature and eight measures in the gray literature, with little overlap between the two sets of measures. Almost all of the measures did not explicitly consider the quality of care. Thus, if quality varies substantially across groups, which is likely in some cases, the measures reflect only the costs of care, not efficiency. Evidence on the measures' scientific soundness was mostly lacking: evidence on reliability or validity was reported for six measures (2.3 percent) and sensitivity analyses were reported for 67 measures (25.3 percent). CONCLUSIONS Efficiency measures have been subjected to few rigorous evaluations of reliability and validity, and methods of accounting for quality of care in efficiency measurement are not well developed at this time. Use of these measures without greater understanding of these issues is likely to engender resistance from providers and could lead to unintended consequences.
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Fiscella K, Epstein RM. So much to do, so little time: care for the socially disadvantaged and the 15-minute visit. ARCHIVES OF INTERNAL MEDICINE 2008; 168:1843-52. [PMID: 18809810 PMCID: PMC2606692 DOI: 10.1001/archinte.168.17.1843] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
There is so much to do in primary care, and so little time to do it. During 15-minute visits, physicians are expected to form partnerships with patients and their families, address complex acute and chronic biomedical and psychosocial problems, provide preventive care, coordinate care with specialists, and ensure informed decision making that respects patients' needs and preferences. This is a challenging task during straightforward visits, and it is nearly impossible when caring for socially disadvantaged patients with complex biomedical and psychosocial problems and multiple barriers to care. Consider the following scenario.
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Affiliation(s)
- Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine & Dentistry, 1381 South Ave, Rochester, NY 14620, USA.
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Hibbard JH, Greene J, Tusler M. Does enrollment in a CDHP stimulate cost-effective utilization? Med Care Res Rev 2008; 65:437-49. [PMID: 18403783 DOI: 10.1177/1077558708316686] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Consumer-driven health plans (CDHPs) are built on the assumption that with increased cost sharing consumers will select cost-effective evidence-based care. In this study, the authors explore whether patterns of utilization change after enrollment in a CDHP and whether the pattern reflects a shift toward evidence-based care. The study population is comprised of 18,025 employees and their adult dependents. The analysis uses a schema for categorizing claims data into high-priority (evidence-based care) and low-priority (limited or no evidence-based care) utilization. The findings indicate that enrollment in CDHPs resulted in a reduction of office visits in the 1st year of enrollment. These reductions in care appear to be indiscriminant, with patients cutting back in both high-and low-priority visits. The reductions in high- and low-priority visits were greater for employees with lower education and income.
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Abstract
BACKGROUND Policies that increase patients' share of health care expenses decrease the use of discretionary health services but also may reduce the use of important preventive care such as mammography. METHODS We reviewed coverage for mammography within 174 Medicare managed-care plans from 2001 through 2004. Among 550,082 individual-level observations for 366,475 women between the ages of 65 and 69 years, we compared rates of biennial breast-cancer screening in plans requiring cost sharing for mammography with screening rates in plans with full coverage. We also performed a longitudinal analysis of screening rates in plans that changed from full coverage to cost sharing for mammography as compared with rates in matched control plans that did not institute cost sharing. RESULTS The number of plans with cost sharing for mammography, which we defined as requiring a copayment of more than $10 or coinsurance of more than 10% for screening mammography, increased from 3 in 2001 (representing 0.5% of women) to 21 in 2004 (11.4% of women). Biennial screening rates were 8.3 percentage points lower in cost-sharing plans than in plans with full coverage, a difference that persisted in adjusted analyses (P<0.001). The effect of cost sharing was magnified among women residing in areas of lower income or educational levels (P<0.001 for each interaction). Screening rates decreased by 5.5 percentage points in plans that instituted cost sharing and increased by 3.4 percentage points in matched control plans that retained full coverage (P<0.001 for the adjusted analysis). CONCLUSIONS Relatively small copayments were associated with significantly lower mammography rates among women who should undergo screening mammography according to accepted clinical guidelines. For effective preventive services such as mammography, exempting elderly adults from cost sharing may be warranted.
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Affiliation(s)
- Amal N Trivedi
- Department of Community Health, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.
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Peters E, Hibbard J, Slovic P, Dieckmann N. Numeracy skill and the communication, comprehension, and use of risk-benefit information. Health Aff (Millwood) 2007; 26:741-8. [PMID: 17485752 DOI: 10.1377/hlthaff.26.3.741] [Citation(s) in RCA: 324] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Current health care policy emphasizes improving health outcomes and the efficacy of health care delivery by supporting informed consumer choices. At the same time, health information often involves uncertainty, and many people may lack the skills and knowledge to process this information, manage their health and health care, and make informed choices. Innumeracy, an element of poor health literacy, is associated with the comprehension and use of important health information. We review this literature and examine what can be done to help less numerate people act more effectively and take charge of their health.
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Robinson JW, Zeger SL, Forrest CB. A Hierarchical Multivariate Two-Part Model for Profiling Providers' Effects on Health Care Charges. J Am Stat Assoc 2006. [DOI: 10.1198/016214506000000104] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- David Blumenthal
- Institute for Health Policy, Massachusetts General Hospital-Partners Health Care System, Boston, USA
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Abstract
The age-rationing debate of fifteen years ago will inevitably reemerge as health care costs escalate. All age-rationing proposals should be judged in light of the current system of rationing health care by price in the U.S., and the resulting pattern of excess and deprivation. Age-rationing should be rejected as public policy, but recognized as a personal virtue of stewardship among the elderly.
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Affiliation(s)
- Larry R Churchill
- Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
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Hibbard JH. Moving toward a more patient-centered health care delivery system. Health Aff (Millwood) 2005; Suppl Variation:VAR133-5. [PMID: 15471780 DOI: 10.1377/hlthaff.var.133] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Quality-of-care measurement has not kept pace with the recent shift toward policy approaches that rely on patients to contain costs and improve quality. If patients are to play a critical role in care, then the degree to which providers support and improve patients' capabilities for participation must also be part of the quality measurement picture. Quality measures that focus on intermediate patient outcomes (such as self-management ability), that follow the patient over time, and that integrate measurement into the processes of care are necessary to move toward a delivery system that is centered on patients.
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Affiliation(s)
- Judith H Hibbard
- Department of Planning, Public Policy, and Management, University of Oregon, Eugene, USA.
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Marquis MS, Buntin MB, Kapur K, Yegian JM. Using contingent choice methods to assess consumer preferences about health plan design. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2005; 4:77-86. [PMID: 16162027 DOI: 10.2165/00148365-200504020-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
INTRODUCTION American insurers are designing products to contain health care costs by making consumers financially responsible for their choices. Little is known about how consumers will view these new designs. Our objective is to examine consumer preferences for selected benefit designs. METHODS We used the contingent choice method to assess willingness to pay for six health plan attributes. Our sample included subscribers to individual health insurance products in California, US. We used fitted logistic regression models to explore how preferences for the more generous attributes varied with the additional premium and with the characteristics of the subscriber. RESULTS High quality was the most highly valued attribute based on the amounts consumers report they are willing to pay. They were also willing to pay substantial monthly premiums to reduce their overall financial risk. Individuals in lower health were willing to pay more to reduce their financial risk than individuals in better health. DISCUSSION/CONCLUSION Consumers may prefer tiered-benefit designs to those that involve overall increases in cost sharing. More consumer information is needed to help consumers better evaluate the costs and benefits of their insurance choices.
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Nelson DE, Bolen J, Wells HE, Smith SM, Bland S. State trends in uninsurance among individuals aged 18 to 64 years: United States, 1992-2001. Am J Public Health 2004; 94:1992-7. [PMID: 15514242 PMCID: PMC1448574 DOI: 10.2105/ajph.94.11.1992] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2003] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We analyzed state-specific uninsurance trends among US adults aged 18 to 64 years. METHODS We used logistic regression models to examine Behavioral Risk Factor Surveillance System data for uninsurance from 1992 to 2001 in 47 states. RESULTS Overall, uninsurance rates increased in 35 states and remained unchanged in 12 states. Increases were observed among people aged 30 to 49 years (in 34 states) and 50 to 64 years (in 24 states), and increases were also observed among individuals at middle and low income levels (in 39 states and 19 states, respectively), individuals employed for wages (in 33 states), and the self-employed (in 18 states). CONCLUSIONS Among adults aged 18-64, rates of uninsurance increased in most states from 1992 through 2001. Decreased availability of employer-sponsored health insurance, rising health care costs, and state fiscal crises are likely to worsen the growing uninsurance problem.
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Affiliation(s)
- David E Nelson
- Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop K-50, Atlanta, GA 30341, USA.
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Parente ST, Feldman R, Christianson JB. Employee choice of consumer-driven health insurance in a multiplan, multiproduct setting. Health Serv Res 2004; 39:1091-112. [PMID: 15230913 PMCID: PMC1361055 DOI: 10.1111/j.1475-6773.2004.00275.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To determine who chooses a Consumer-Driven Health Plan (CDHP) in a multiplan, multiproduct setting, and, specifically, whether the CDHP attracts the sicker employees in a company's risk pool. STUDY DESIGN We estimated a health plan choice equation for employees of the University of Minnesota, who had a choice in 2002 of a CDHP and three other health plans--a traditional health maintenance organization (HMO), a preferred provider organization (PPO), and a tiered network product based on care systems. Data from an employee survey were matched to information from the university's payroll system. PRINCIPAL FINDINGS Chronic illness of the employee or family members had no effect on choice of the CDHP, but such employees tended to choose the PPO. The employee's age was not related to CDHP choice. Higher-income employees chose the CDHP, as well as those who preferred health plans with a national provider panel that includes their physician in the panel. Employees tended to choose plans with lower out-of-pocket premiums, and surprisingly, employees with a chronic health condition themselves or in their family were more price-sensitive. CONCLUSIONS This study provides the first evidence on who chooses a CDHP in a multiplan, multiproduct setting. The CDHP was not chosen disproportionately by the young and healthy, but it did attract the wealthy and those who found the availability of providers more appealing. Low out-of-pocket premiums are important features of health plans and in this setting, low premiums appeal to those who are less healthy.
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Affiliation(s)
- Stephen T Parente
- Carlson School of Management, Department of Healthcare Management, University of Minnesota, 321 19th Avenue South, Suite 3-149, Minneapolis, MN 55455, USA
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Weiner SJ, VanGeest JB, Wynia MK, Cummins DS, Wilson IB. Falling into Line: The Impact of Utilization Review Hassles on Physicians’ Adherence to Insurance Contracts. THE JOURNAL OF CLINICAL ETHICS 2004. [DOI: 10.1086/jce200415206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Friedman C, McKenna MT, Ahmed F, Krebs JG, Michaud C, Popova Y, Bender J, Schenk TW. Assessing the burden of disease among an employed population: implications for employer-sponsored prevention programs. J Occup Environ Med 2004; 46:3-9. [PMID: 14724472 DOI: 10.1097/01.jom.0000105915.59342.9a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Escalating healthcare costs have led employers to identify ways to assess the actual burden of disease among their employees. One such measure is the use of disability-adjusted life-years (DALYs). DALYs were calculated for the General Motors (GM) population for 1994 through 1998 using data from GM's Mortality Registry, published life tables, and age- and sex-specific disease incidence and disability data from the U.S. Burden of Disease Study. Chronic diseases accounted for 45% (245,844 of 540,450) of total DALYs lost. Ischemic heart disease, stroke, lung cancer, and chronic obstructive pulmonary disease led the list for both men and women and accounted for 39% and 31%, respectively, of the top 10 DALYs lost. Disease burden among employees could be reduced through targeted interventions aimed at the risk factors associated with the leading causes of DALYs.
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Affiliation(s)
- Carol Friedman
- Epidemiology Program Office, Cancer Surveillance Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Abstract
PURPOSE The purpose of this study was to demonstrate the feasibility and results of ascertaining Medicare enrollees' priorities for insured medical benefits. DESIGN AND METHODS Structured group exercises were conducted with Medicare enrollees from clinical and community settings in central North Carolina. By participating in a decision exercise, CHAT: Choosing Healthplans All Together, individuals and groups chose medical benefits within the constraints of a monthly Medicare + Choice premium. The acceptability of the exercise and the resulting benefit package were assessed. RESULTS Ten groups (121 individuals) made trade-offs that involved the selection of more tightly managed care in order to add pharmacy, dental, and long-term care benefits. All were willing to forgo experimental therapy; 7 groups gave priority to insuring the uninsured. Participants found the exercise overwhelmingly acceptable and were willing to abide by their groups' choices. IMPLICATIONS Medicare enrollees are able to come to consensus about financially constrained benefit packages that may be useful in reform of the Medicare program.
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Affiliation(s)
- Marion Danis
- Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892-1156, USA.
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Freudenberg N. Community Health Services for Returning Jail and Prison Inmates. JOURNAL OF CORRECTIONAL HEALTH CARE 2004. [DOI: 10.1177/107834580301000307] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Robinson JC. Hospital tiers in health insurance: balancing consumer choice with financial incentives. Health Aff (Millwood) 2004; Suppl Web Exclusives:W3-135-46. [PMID: 14527246 DOI: 10.1377/hlthaff.w3.135] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Variations in efficiency and market power are generating wide variations in the prices charged by hospitals to health insurance plans. Insurers are developing new network structures that expose the consumer to some of the cost differences, to encourage but not mandate differential use of the more economical facilities. The three leading designs include hospital "tiers" within a single broad network, multiple-network products, and the replacement of copayments by coinsurance in HMO as well as PPO products. This paper describes the new network designs and evaluates the challenges they face in influencing consumers' behavior, incorporating information on clinical quality, and supporting medical education and uncompensated care.
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Affiliation(s)
- James C Robinson
- School of Public Health, University of California, Berkeley, USA
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Cooksey C, Lanza AP. Examining diabetes health benefits in health plans of large employers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2004; Suppl:S30-5. [PMID: 14677328 DOI: 10.1097/00124784-200311001-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Components of the contract specifications (also known as model purchasing specifications) for diabetes care that were developed by George Washington University (Washington, D.C.) and the Centers for Disease Control and Prevention were applied to 20 health plans from two Fortune 500 companies as well as the Federal Employee Health Benefits Plan to investigate the extent of diabetes-related benefits available to employees. Diabetes-related benefits covered a range of services and supplies that include insulin, physician visits, immunizations, diabetes preventive assessments, foot and eye exams, hemoglobin A1c tests, orthotics, diabetes self-management education, case management, smoking cessation, obesity treatment, and exercise training. The 20 health plans included health maintenance organizations, preferred provider organizations, point of service plans, and one indemnity plan. Services and supplies were assigned to three tiers: tier 1, general diabetes care; tier 2, specialty diabetes care; tier 3, lifestyle services. Services and supplies were considered covered even if they required authorization by the provider (e.g., doctor referral, recommendation, or prescription) or the health plan. Tier 1 services and supplies received more comprehensive coverage by all health plans. Differences in coverage were more notable in tiers 2 and 3 than in tier 1. Tier 3 (lifestyle services) received less coverage than tiers 1 and 2.
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Affiliation(s)
- Clay Cooksey
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop K-10, Atlanta, GA 30341-3717, USA.
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Abstract
Clinicians and the organizations within which they practice play a major role in enabling patient participation in cancer screening and ensuring quality services. Guided by an ecologic framework, the authors summarize previous literature reviews and exemplary studies of breast, cervical, and colorectal cancer screening intervention studies conducted in health care settings. Lessons learned regarding interventions to maximize the potential of cancer screening are distilled. Four broad lessons learned emphasize that multiple levels of factors-public policy, organizational systems and practice settings, clinicians, and patients-influence cancer screening; that a diverse set of intervention strategies targeted at each of these levels can improve cancer screening rates; that the synergistic effects of multiple strategies often are most effective; and that targeting all components of the screening continuum is important. Recommendations are made for future research and practice, including priorities for intervention research specific to health care settings, the need to take research phases into consideration, the need for studies of health services delivery trends, and methods and measurement issues.
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Affiliation(s)
- Jane G Zapka
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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29
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Abstract
PURPOSE The purpose of this review is to analyze the current health care environment and its impact on urological practice. MATERIALS AND METHODS The medical and lay literature as it pertains to the socioeconomics of health care was reviewed. RESULTS Analysis of the political and economic factors that influence the delivery of health care today reveals alarming realities. More than 40 million Americans remain uninsured, and with a retrenched economy that number is likely to increase. Neither government nor the private sector has been either willing or able to address the health care problem in a coherent or comprehensive way. As the population ages, the Medicare and Medicaid programs will become further stressed. Employers are increasingly unwilling to finance the health care expenses of their employees. Academic medical centers are facing unique exigencies that, if left uncorrected, will jeopardize the future training of physicians. CONCLUSIONS In the current environment of a depressed economy, further proposed tax cuts and increased military spending it appears inevitable that the economic restraints on medical care will increase substantially in the foreseeable future.
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Affiliation(s)
- Kevin R Loughlin
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Legorreta A. Changing health insurance trends. N Engl J Med 2003; 348:365-7; author reply 365-7. [PMID: 12540658 DOI: 10.1056/nejm200301233480421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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32
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Yegian JM. Tiered Hospital Networks. Health Aff (Millwood) 2003; Suppl Web Exclusives:W3-147-53. [PMID: 14527247 DOI: 10.1377/hlthaff.w3.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As a result of rising health care costs, health plans are experimenting with insurance products that shift greater financial responsibility for medical care to consumers and create incentives for consumers to consider cost differences when choosing among providers. Based on an October 2002 roundtable discussion, this paper discusses insurance product trends, particularly tiered hospital networks. Issues addressed include these product features' potential to reduce system costs, the effect on the hospital-health plan relationship, consumers' ability to consider cost and quality in decision making, and financial barriers to care for the chronically ill.
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Abstract
The value of genetics in medicine has been steadily developing with our increasing knowledge of the human genome. Genetic testing to determine disease risk or potential drug effects is set to become more commonplace. With this comes increasing concern about access to genetic information, and the potential for discriminatory usage of such information. At present, the scope and predictability of genetic testing and the conclusions that may be drawn fairly from genetic information are limited. Nonetheless, public concerns about discrimination based on the possession of a genetic trait or condition are well documented. The prospect that such information might be used in decisions regarding employment or insurability has caused anxiety and prompted legislation largely dedicated to the use of information about one's genotype rather than medical information in general. These laws emphasize genetic information as distinct from other medical information and attempt to prioritize interests in genetic information. As the distinction between genetic and medical information becomes untenable, those who would regulate the use of genotypic information will find this approach to policy problematic.In considering the limits of legislation as an effective tool of regulating genetic discrimination, several conclusions can be drawn: firstly, despite the promise of genomic medicine, current knowledge is insufficient to justify the use or application of certain genetic information in nonmedical contexts; secondly, public resistance to genomic medicine that is based on fear of genetic discrimination poses a danger that justifies a policy response; and thirdly, such a response may be purely symbolic and not entirely effective, provided that the policy establishes a consensus regarding the applicability of genetic information in nonmedical contexts.
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Affiliation(s)
- Phyllis Griffin Epps
- University of Houston Health Law & Policy Institute, Houston, Texas 77204-6060, USA.
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