How companies tackle health care costs: Part III.

As corporations look for ways to cut the rising costs of health care, they direct most of their efforts at modifying the demand for services. Some have attempted to effect changes in the health care system as a whole, and a smaller number have instituted programs to attack the problem at its source by improving the health of their employees. This article explores and evaluates existing corporate health promotion activities and concludes that such programs should form the third part of a three-pronged attack on health care costs.     

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.     

New post‐ACA insurance data highlights health insurer spending on health care quality

Following the Patient Protection and Affordable Care Act (ACA), annual financial reports by commercial health insurers include more detailed information on a Supplemental Health Care Exhibit. In this new exhibit, insurers illustrate spending on the provision of medical services and associated expenses. These expenses, which were commonly reported as “claims adjustment” and “general administrative” expenses, can now be allocated to several new categories of expenses associated with combatting fraud and improving patient health care quality. This article illustrates that quality improvement expenses have increased significantly in the individual, small group, and large group markets following implementation of the ACA. Of the five types of quality expenses reported, the greatest proportion of spending has been toward the improvement of health outcomes and the most pronounced increase from 2011 to 2017 has been spending toward increased wellness and health promotion activities, which include activities such as wellness assessments and coaching programs for patients with chronic diseases. Given that the ACA was designed not only to broaden access to health insurance but also to improve health, analysis of the allocations to various types of quality improvement activities highlights the private market's contribution to improving the health of the US population.     

Evolutionary theory in public health and the public health of evolutionary theory

Evolutionary theory is the most powerful explanatory system in the life sciences and is the only framework that can unify knowledge in otherwise disparate fields of research. Considerable advances have been made in the application of evolutionary biology to health issues in recent decades. Health researchers and practitioners could benefit considerably from an understanding of the basic principles of evolution and how humans have been shaped by natural and sexual selection, even if they are not explicitly testing evolutionary hypotheses. Life History Theory is a powerful framework that can be used for examining modern human environments and developing environments that maximize opportunities for positive health outcomes. Many of the recommendations derived from this framework converge with the visions of current public health advocates. Despite the benefits of an evolutionary framework, the challenges that face those attempting to integrate evolutionary theory into public health are perhaps greater than those in the social sciences. Although considerable advancements in the understanding of health issues have already been made, health researchers with an evolutionary perspective are very few in number and face constraining disciplinary attributes. Advances in medical technology will continue to extend the boundaries of saving lives in danger, however traditional public health efforts may be reaching their limits of effectiveness in encouraging health-promoting behaviors. This may partially account for the current interest in broad social and policy change to enhance health and reduce health disparities amongst sub-populations. Such substantial physical and social restructuring will face many challenges and gradual progress may be enhanced by a strong foundation of evolutionary human science. The slow but eventual integration of evolutionary principles will gradually enhance the effectiveness of health interventions and provide an ultimate explanation for patterns in health outcomes that are otherwise puzzling. The speed at which the field of public health adopts a Darwinian framework has yet to be determined, and several futures are possible. This pace will depend on several factors, including the visible utility of evolutionary theory for addressing the health promotion goals of the field.     

Communicating with the public during health crises: experts' experiences and opinions

Governments and health agencies worldwide are planning for a potential influenza pandemic. Their plans acknowledge the importance of public communication during an outbreak and include related guidelines and strategies. Emerging infectious disease (EID) communication is a new addition to the literature, drawing on health promotion communication, crisis communication and environmental/technological risk communication. This paper adds to the literature, exploring the notion of ‘effective communication during health crises' by reporting on interviews with 22 public health officials, scientists and communications professionals responsible for communicating with the public. When analyzed in the context of the risk communication literature, the interviews reveal several considerations for health risk communicators. First, given the important role that mass media will play in an EID outbreak, there is an urgent need for public health to build partnerships with journalists based on an understanding of the two parties' unique societal roles. Second, seemingly practical communications considerations – such as how certain to be about information before sharing it and whether to engage in two‐way communication with the public – have ethical dimensions that deserve attention. Third, there are unique challenges associated with communicating uncertainty, which would benefit from an exploration of the role of trust in health crisis communication.     

WHO''s health futures consultation

The World Health Organization's 1993 consultation on health futures examined the field from perspectives of the macro-environment, health status, health resources, emerging health technology, alternative care systems, and tools for health futures research. The consultation produced numerous suggestions about how WHO could promote and support health futures work. Among the ideas now being implemented are new efforts in global surveillance of infectious diseases, the publication of health futures articles, the establishment of an electronic health futures bulletin board, and preparation of a handbook for health futures studies.     

reDefined contribution health care

To combat rising health care costs and a society increasingly unsatisfied with employer-sponsored health care services, reDefined Contribution Health Care suggests a process to create a more consumer-driven health care market. To create this value-sensitive market requires a planned, staged approach that will include immediate actions and work toward fundamental, long-term changes.     

The employer's case for health management

Employers' past solutions to rising health benefit costs--adopting managed care strategies, cost shifting to employees and reducing benefits-are no longer effectively controlling costs and are depressing the value of health benefits for employee recruitment and retention. An alternative strategy is to implement health management approaches that improve the health status of employees. These programs reduce medical costs and have a documented positive impact on workers' compensation, disability costs, absenteeism and productivity. Further, this approach is complementary to health care consumerism as a strategy for health improvement and benefit cost reduction and results in improved employee health, outlook and satisfaction.     

Defined contribution health plan to consumer driven health benefits: evolution and experience

Today, the idea of placing more choice on employees "consuming" health care and giving them more responsibility and incentive to control health care costs and utilization is alive and thriving in the form of consumer-driven health care. This article examines the evolution of consumer-driven health benefits--including the experience of the first generation of "defined contribution" health care participants (i.e., retirees) and the results of different approaches employers have taken to early consumer-driven plan designs. The author then describes what's needed to answer the question: "Can consumer-driven health care control health cost?"     

Work and common health problems

This paper reviews the evidence on the relationship between work and health. It concludes that, overall, the beneficial effects of work outweigh the risks of work, and are greater than the harmful effects of long-term worklessness. That contrasts with increasing trends of sickness absence, long-term incapacity and ill-health retirement attributed to common health problems. It suggests that there needs to be a fundamental shift in how we think about common health problems and work--in health care, the workplace and society.     

Household portfolio choices,health status and health care systems: A cross-country analysis based on SHARE

Health risk is increasingly viewed as an important form of background risk that affects household portfolio decisions. However, its role might be mediated by the presence of a protective full-coverage national health service that could reduce households’ probability of incurring current and future out-of-pocket medical expenditures. We use SHARE data to study the influence of current health status and future health risk on the decision to hold risky assets, across ten European countries with different health systems, each offering a different degree of protection against out-of-pocket medical expenditures. We find robust empirical evidence that perceived health status matters more than objective health status and, consistent with the theory of background risk, health risk affects portfolio choices only in countries with less protective health care systems. Furthermore, portfolio decisions consistent with background risk models are observed only with respect to middle-aged and highly-educated investors.     

Assessing health plan quality

Health plan accreditation and report cards represent the beginning of a rapidly evolving information flow that impacts all stakeholders within the health care system. By understanding what information is available--and its limitations--stakeholders can work together to promote improved health plan quality.     

我国健康保险业的健康管理运行模式构建

健康管理是健康保险转移财务风险、控制成本、解决信息不对称、道德危害等问题的成功策略之一。积极借鉴国外保险业健康管理的成功运行模式(如HMO,PPO,POS等),构建我国健康保险的健康管理运行模式对于我国健康保险业的可持续发展有着重大意义。本文重点研究了健康管理运行模式的重要组成部分:服务人群、服务方式、服务内容、支付机制、成本控制与医疗服务管理机制、利益协调机制、反馈机制等,并探讨了健康管理当前在我国面临的问题,指出必须结合国情构建健康管理运行模式,从而促进我国健康保险业务稳定、持续、健康的发展。     

The mental health paradox

The authors review the evidence that mental health coverage pays for itself by reducing overall health care costs, satisfies and helps patients who receive it, reduces employee absenteeism and improves employee functioning. They then explain the factors contributing to the decline in mental health services valuations and what employers can do to minimize them.     

Value-based partnering in health care

Many companies are beginning to focus on value in their health care purchasing decisions, and some are going beyond value-based purchasing to value-based partnering. Value-based partnering recognizes the interdependencies among stakeholder groups in the health care system and creates a strategic reason for them to exchange information and create long-term strategic alliances. This article discusses the principles of value-based partnering, impediments to practicing it and its future role in the health care system.     

The future of health futures

Health futures represents the application of various futures tools to the arenas of health and health care. This special issue of Futures reflects the significant growth of health futures. Health and health-care systems can be far better by the early 21st century, or they could be worse. Health futures enables individuals, organizations and communities to understand better the threats and opportunities facing their health, both of which are profound. The International Health Futures Network is an indicator of the growth of this subfield of futures. The future of health futures will be shaped by the ability of futures techniques and those who use them to provide value to organizations and individuals. Better networking among health futurists, expert systems, and the ability to measure and communicate quality will be essential.     

A vision for Nicaragua : Health services in the new century

Nicaragua is facing a crisis in health and health care, and a health futures programme has been initiated to focus concern and mobilize key actors. Two national scenario workshops have been held at which participants constructed several scenarios describing alternative health futures for the country, with particular emphasis on the organization of health services. One or these, a scenario of profound change, was selected by the participants as their vision of the preferred future. It involves more emphasis on health promotion, decentralization of health-care services, broader participation in health matters, improved training for health professionals, and a stronger role for universities and other educational and research centres. Implications of the selected scenario regarding health policies and actions have been identified, among them being the adoption and implementation of the Ottawa Charter on Health Promotion, the organization of local health service networks, and the more active involvement of health professionals in the designing of health systems.     

Community health care in developing countries

Health care systems in many developing countries have shared characteristics. Government expenditures in poor countries are low for health care. The majority of people cannot easily reach a modern health facility. Most spending is for high-cost curative medicine, e.g., hospitals. Programs are often inefficient in their use of funds. The tragedy of disease in developing countreis is that many of the most serious problems are either preventable or curable by simple, inexpensive, safe methods. About 16 million children under age 5 died in 1979 in developing countries; 5 million of these deaths could have been prevented by immunization against measles, polio, tetanus, diphtheria, whooping cough, and typhoid. Many countries are establishing community-level health care facilities that use community health workers instead of doctors. A 3-tiered program is being adopted in some areas: the community health center, the rural or urban polyclinic, and the referral hospital. The community health center seeks to provide two-thirds of the needed services, including supervision of pregnancy, midwifery, care of new-born children, treatment of endemic diseases, and emergency care for injuries. Early experience has taught that it is more important for the community health worker to have practical experience and the respect of the people he serves than formal education. Improvements in nutrition, hygiene, and sanitation are needed to reach the full health potential of most communities.     

Consumer-centered vs. job-centered health insurance

Most employees and their dependents in the United States have health insurance provided by the employer or labor-management health and welfare fund. In this system, employees and their families lose their health insurance when the breadwinner loses his or her job while, at the same time, a Medicaid beneficiary can lose Medicaid eligibility by getting a job, even a poorly paid one. Most health insurance pays the doctor on the basis of fee-for-service and the hospital on the basis of cost-reimbursement, rewarding both with more revenue for providing more and more costly services. The insured employee has little or no incentive to seek out a less costly provider. There are no rewards for economy in this system. It should be little wonder, then, that health care costs are out of control. There are alternative financing and delivery systems with built-in incentives to use resources economically, but, the author of this article asserts, their ability to compete and attract patients with their superior economic efficiency is blocked by many laws and government programs. The author believes that the most effective and acceptable way to get costs under control, and at the same time achieve universal coverage, would be through a system of fair economic competition. He discusses his Consumer Choice Health Plan proposal and describes how one of the main barriers to competition is today's system of job-linked health insurance.     

Redefining competition in health care

The U.S. health care system is in bad shape. Medical services are restricted or rationed, many patients receive poor care, and high rates of preventable medical error persist. There are wide and inexplicable differences in costs and quality among providers and across geographic areas. In well-functioning competitive markets--think computers, mobile communications, and banking--these outcomes would be inconceivable. In health care, these results are intolerable, with life and quality of life at stake. Competition in health care needs to change, say the authors. It currently operates at the wrong level. Payers, health plans, providers, physicians, and others in the system wrangle over the wrong things, in the wrong locations, and at the wrong times. System participants divide value instead of creating it. (And in some instances, they destroy it.) They shift costs onto one another, restrict access to care, stifle innovation, and hoard information--all without truly benefiting patients. This form of zero-sum competition must end, the authors argue, and must be replaced by competition at the level of preventing, diagnosing, and treating individual conditions and diseases. Among the authors' well-researched recommendations for reform: Standardized information about individual diseases and treatments should be collected and disseminated widely so patients can make informed choices about their care. Payers, providers, and health plans should establish transparent billing and pricing mechanisms to reduce cost shifting, confusion, pricing discrimination, and other inefficiencies in the system. And health care providers should be experts in certain conditions and treatments rather than try to be all things to all people. U.S. employers can also play a big role in reform by changing how they manage their health benefits.