Hospital use behaviors and associated costs in a health insurance organization, Japan

Physicians are known to play an important role in the rise of health care costs. But patients--the other side of the chain of health care systems--have been given little attention. The present study utilized the outpatient claims (in the belief that the outpatient hospital visits are mainly decided by the patients) from a health insurance organization in Japan (the Fukuoka Prefecture public service mutual aid association for government employees who serve in small cities, towns, and villages) to analyze the employee behaviors in the use of hospital care and the costs associated with these behaviors. Number of diseases diagnosed for an employee, number of claims an employee submitted for one disease, number of hospitals an employee visited, number of claims an employee had from one hospital, and the total number of claims an employee submitted were used to describe the hospital use behaviors. Results showed that some employees exhibited unusual behaviors, characterized by having an extremely large number of diseases diagnosed, visiting a large number of different hospitals, having a large number of claims, etc. Higher medical expenditures were associated with such behaviors. The findings of this study suggest that the patients' role in the rise of health care costs cannot be ignored, and cost-containment strategies targeting modification of patient behaviors in the use of hospital care may prove to be very useful.     

Consumer-driven health care: the future is now

Given that managed care seems to have run its course, employers are forced to deal with escalating health care costs by reducing benefits and lowering pay--or are they? Why not bring the power of the responsible, informed consumer to health care? Consumer-driven health care offers a new, economically rational direction that can simultaneously address the needs of both employers and employees. This article reviews the factors leading to the need for consumer-driven health care and describes the characteristics and benefits of its current and next generations of development.     

Communicating the need for additional savings in the face of retiree health benefit cutbacks.

In preparing for retirement, employees need to consider not only their pension benefits but also the challenge of financing their retirement health care needs. Various trends evolving in our society indicate that future retirees will be increasingly dependent on their own retirement savings. Evidence suggests that employees are not fully aware of the significance of health costs in retirement and must be educated to the need to save for retiree health care expenses. This article discusses the issues of Medicare reduction and retiree health benefit cutbacks and the relative communication and education challenges such issues pose to employers.     

Preparing for Medicaid managed care

As Medicaid enrollment continues to rise, hospitals and health systems could benefit from contracting with Medicaid managed care plans. Providers need to establish a Medicaid managed care strategy before beginning the contracting process. Revenue cycle leaders need to ensure that their front-end processes related to patient access, billing, and denials management are compatible with Medicaid managed care.     

Health care reform and reform for health: creating a health system for communities in the 21st century

If we are to improve the health of the population and reduce the inequalities in health that plague our communities and our planet, we will have to give greater attention to the determinants of health. The reform of the health care system, necessary though it is, will never be sufficient; we need to reform our whole society and in particular to focus on human rather than economic development. At the community level we need to create healthy communities that are “health-creating systems” of environmental, social and human development, as well as health care systems that focus first on improving and maintaining health. Such a “bottom-down” health care system would see the hospital become once again the place of last resort (but still a potentially important partner in creating healthier communities) and would focus instead on how to provide health promotion and health care from the household level up.     

Genetic enhancement, futures tense

This article reviews central developments on the intersections of genetics research, genetic counselling and bioethics that, in the 1970s and 1980s came together in the construction of the genetic decision maker through an “enhancement imaginary”. It argues that this image of genetic decision making, along with emerging socio-economic developmental traits in the West, will come under increasing pressure. This will generate the need for an up-scaled decision making complex, incorporating digital means and cognitive science in contexts increasingly outside of health care institutions. The handling of information, identity and decision making under changing and complex circumstances becomes central. Such developments raise concerns about, simultaneously, increasing surveillance, social inequality and exclusion, and emerging expert/lay relations. New attitudes, institutions and forms of knowledge are needed to meet emerging genomic futures in constructive ways.     

Confronting the fear factor: the coverage/access disparity in universal health care

Since their introduction following World War II, single-payer health care systems and universally mandated health care systems have stumbled, but in their pratfalls are many lessons that apply to the universal health care proposals currently on the table in the United States. The critical and often-over-looked point is that universal coverage does not guarantee that individuals will receive needed care--In many cases guaranteed access to care is a false promise or available only on a delayed timetable. A more feasible alternative lies in providing a safety net for citizens who truly need care and financial support with an appropriate system of checks and balances--without disrupting the economic and actuarial fundamental principles of supply and demand and risk classification.     

Here it comes: defined contribution health care

The Patient Protection and Affordable Care Act includes provisions to make the individual health insurance marketplace one where all Americans, including those with preexisting health conditions, can obtain affordable coverage. At the same time, the act has failed to address, in any significant way, many of the underlying flaws in the current U.S. health care system that have caused costs to spiral out of control. The combination of persistent U.S. health care cost increases and a viable individual health insurance marketplace will cause a sea change in employer-sponsored health care offerings that is similar to that seen among employer-sponsored retirement benefit plans: movement away from defined benefit approaches and toward defined contribution designs. Although the authors show parallels between the evolution of employers' health care and retirement offerings, they explain why certain key developments will need to occur before defined contribution approaches become as prevalent in employer-sponsored health care plans as they are in today's employer-sponsored retirement plans.     

Concern or apathy: the attitude of the public toward urban air pollution

It is important to understand public attitudes when designing policy instruments to motivate actions. Attitude is partially socially constructed and thus must be studied locally rather than inferred from other settings. This study explored public attitudes toward air pollution among Beijing residents through interviews and thematic analysis. In contrast to previous studies mostly focusing on a certain dimension of attitudes, we attempted to show an initial picture of attitudes in three dimensions, knowledge and belief, perception and concern, and covert and overt behaviors, and identify underlying factors accounting for such attitudes. The results showed that the interviewees largely knew the sources and impacts of air pollution but also demonstrated misunderstandings; half of them perceived air pollution as ‘severe’ and three-fourths of them showed little concern about air pollution; their protective and mitigation responsive behaviors were inadequate. Factors affecting such attitudes, both existing and missing in current literature, were identified. Perceived air pollution is determined by sensory cues and imagination, and mediated by lived experiences and place identity. Lack of concern about air pollution can largely be explained by a feeling of uncontrollability and the crowding effect in competing for attention. This lack is further influenced by the perceived benefits of living in large cities, perceived fairness of the impact across the population, and perceived delay of the health impacts posed by air pollution. Protective behaviors, specifically wearing facemasks, are influenced by perceived severity, vulnerability, efficacy, and barriers. Mitigation behavior, which refers to reducing car use in this case, is discouraged by a lack of feeling responsible and by perceived inconvenience and ineffectiveness. At an academic level, the results of this exploratory study are expected to provide a base for further investigations of factors affecting public attitudes. From a policy perspective, the results should provide information for designing policy instruments to raise awareness and motivate actions to cope with air pollution.     

Health and the welfare of U.S. business

Business leaders continue to blame the skyrocketing cost of health care for jeopardizing the global competitiveness of U.S. industries, and they continue to turn to Washington for the solution. Yet after a study of 16 countries, Wharton researchers David Brailer and R. Lawrence Van Horn have discovered that health care costs do not directly hinder U.S. competitiveness. Their conclusion: there is indeed a health care crisis in the United States as well as a competitiveness crisis. But the two are unrelated, and confusing them makes it difficult to solve either one. The real problem, according to the authors, is the hands-off approach that employers typically adopt when it comes to health care. No matter how Washington responds to the health care crisis, employers must explore their own role in ensuring the health of their work force. And they must realize that their role can be a strategic one. Instead of containing costs by fine-tuning benefits packages, companies can control costs and improve health care delivery by treating health care like any other crucial component of production. Brailer and Van Horn propose three strategies for managing health care delivery: First, companies must intervene in the supply side of the health care market. This may mean creating a clinic alone or with other companies, or joining with other companies to procure health care. Second, companies need to translate corporate health benefits into the most cost-effective set of services at the local level. Finally, companies must encourage and educate employees to participate in decisions regarding health care delivery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Epilogue: health care reform and productivity

Only a health care system that balances the best interests of consumers with those of employers and government payers will ultimately provide quality care at manageable costs. These need not be opposing interests.     

Attacking the disability and absenteeism epidemic--behavioral health care solutions

To remain competitive in a global economy, employers must implement effective programs to stem escalating disability claims and increased costly absenteeism. This article discusses methods to counter this latest workforce epidemic. The authors discuss employee attitudes, legal considerations and behavioral health care solutions.     

The return of capitation preparing for population-based health care

To succeed under population-based health care, organizations need to understand thoroughly how this approach differs from traditional fee-for-service health care. To manage care under capitation, the contracting organization should have a population of sufficient size and a clear means of assigning patients to that population. To assess performance, the organization requires metrics that view performance in terms of per member per month, while avoiding common pitfalls of misapplying such metrics.     

The secret to a health benefits self-service model: a more informed consumer

Sageo is the first full-service e-business to deliver health, dental, vision and welfare benefits via the Internet. The author describes the health care system's problems that have led to the need for participant-driven, self-service systems; describes Sageo's genesis and inaugural online enrollment; and explains how services like those offered by Sageo allow employers to "match, pace and lead" to a more informed health care consumer.     

Defining the road ahead: thinking strategically in the new era of health care reform

Understanding the implications of the new health care reform legislation, including those provisions that do not take effect for several years, will be critical in developing a successful strategic plan under the new environment of health care reform and avoiding unintended consequences of decisions made without the benefit of long-term thinking. Although this article is not a comprehensive assessment of the challenges and opportunities that exist under health care reform, nor a layout of all of the issues, it looks at some of the key areas in order to demonstrate why employers need to identify critical pathways and the associated risks and benefits of each decision. Key health care reform areas include insurance market reforms, grandfather rules, provisions that have the potential to influence the underlying cost of health care, the individual mandate, the employer mandate (including the free-choice voucher program) and the excise tax on high-cost plans.     

Let's put consumers in charge of health care

Businesses spend billions on health insurance. And what do they get for their money? A lot of unhappy employees. Workers fret about the quality of the care they receive, the burden of their out-of-pocket expenses, and the gaps in their coverage. For businesses, health care has become a lose-lose proposition: They pay way too much, and they get way too little. The problem is that the health care industry has been shielded from consumer pressure--by employers, insurers, and the government. As a result, costs have exploded even as choices have narrowed. But if companies embrace a new model of health coverage--one that places control over both costs and care directly into the hands of employees--the competitive forces that spur productivity and innovation in consumer markets can be loosed upon the inefficient, tradition-bound health care system. Moving to consumer-driven health care requires that companies revamp their health benefits in six ways: Give employees incentives to shop intelligently; offer a real choice of insurance plans; charge employees prices that accurately reflect the company's costs; let providers set their own prices; adjust payments for each enrollee based on need; and provide relevant information. Putting consumers in charge of health care may seem like a radical approach. But individuals are highly motivated to educate themselves about their health, their insurance, and their care, and they want to seek the most value for their money. Promoting that economic dynamic--the same that fuels consumer markets everywhere--is the best way to enhance the health care industry's productivity and quality.     

Automation is key to managing a population's health

Online tools for automating population health management can help healthcare organizations meet their patients' needs both during and between encounters with the healthcare system. These tools can facilitate: The use of registries to track patients' health status and care gaps. Outbound messaging to notify patients when they need care. Care team management of more patients at different levels of risk. Automation of workflows related to case management and transitions of care. Online educational and mobile health interventions to engage patients in their care. Analytics programs to identify opportunities for improvement.     

Traffic risk perception,road safety attitudes,and behaviors among road users: a comparison of Turkey and Norway

The present study aims to investigate differences in road safety attitudes, driver behavior, and traffic risk perception between Turkey and Norway. A questionnaire survey was conducted among a sample of Norwegian (n?=?247) and Turkish (n?=?213) road users. The results show that Turkish respondents perceived traffic risk to be higher than Norwegian respondents. Turkish respondents reported safer attitudes towards drinking and driving than Norwegian respondents, while Norwegians reported safer attitudes towards speeding. Turkish respondents reported a lower frequency of speeding behaviors than Norwegian respondents, whereas Norwegian respondents reported a lower frequency of drinking and driving. Traffic risk perception was related to road safety attitudes and behaviors among Norwegian respondents but not among Turkish respondents. The results were discussed with respect to differences in traffic safety, traffic culture, and the development levels in Turkey and Norway.     

Prospects for account-based health plans under the Patient Protection and Affordable Care Act

Account-based health plans (ABHPs), which combine high-deductible plans with either health reimbursement arrangements (HRAs) or health savings accounts (HSAs), have gained popularity in recent years. Because there is growing evidence these plans are indeed engaging consumers and moderating cost increases, employers will need ABHP design options as they strive to bring costs under control in coming years. Some observers, however, are now concerned that benefits standards introduced by federal health care reform will undermine these plans, and many in the business community anticipate new health benefits mandates will drive up employers' total health care costs. The authors show that although the Patient Protection and Affordable Care Act (PPACA) of 2010 includes numerous provisions that will likely increase costs for employers, the law also accommodates, and may even foster, HSAs and HRAs.