The consumer-driven approach: defining and measuring success

Employers' reluctance to implement consumer-driven health plans (CDHPs) is at least in part due to their not understanding how to define and measure the success of CDHPs. To assist employers, the authors define potential points of success for CDHPs in the areas of consumer engagement, consumer financial considerations and employee health and productivity. They then offer ways of measuring success in those areas, as well as in the area of employer cost control. By taking a carefully considered approach to the decision of whether to offer a CDHP, employers can grasp potential opportunities to control health care costs.     

More preventive care, and fewer emergency room visits and prescription drugs--health care utilization in a consumer-driven health plan

Although consumer-driven health plans (CDHPs) have grown dramatically, the question of whether CDHPs have reduced health care costs has not been answered definitively. This article presents what the authors believe to be the first study to analyze a large sample of claims data and to look in detail at different types of utilization among enrollees in a CDHP and those in a traditional comprehensive major medical (CMM) plan. After adjusting for the finding that CDHP enrollees are both younger and healthier than those in CMM plans, the authors found that CDHP enrollees show no consistent or significant utilization differences for measures over which consumers have little control (e.g., inpatient stays); lower utilization for measures over which consumers have greater control (e.g., emergency room visits); and higher utilization of preventive services.     

Consumerism and wellness: rising tide, falling cost

Annual employer-sponsored health plan cost increases have been slowing incrementally due to slowing health care utilization--a phenomenon very likely tied to the proliferation of health management activities, wellness programs and other consumerism strategies. This article describes the sharp rise in recent years of consumer-directed health plans (CDHPs) and explains what developments must happen for genuine consumer-directed health care to realize its full potential. These developments include gathering transparent health care information, increasing consumer demand for that information and creating truly intuitive data solutions that allow consumers to easily access information in order to make better health care decisions.     

Perceived health risks and perceptions of expert consensus in modern food society

The article deals with perceptions of food and health risks. Relevant questions are: (1) To what degree do consumers associate specific negative health consequences with food additives and genetically modified food, and do their perceptions differ from the experts’ views? (2) How do consumers perceive experts’ evaluations of health risks connected to food additives and genetically modified food? The results are based on a survey of Norwegian residents in 1999/2000, and of a selected sample of Norwegian experts on food and risks. There were great differences between consumers and experts in their assessments of health risks. To varying extents, consumers associate various health consequences with the risk factors. Consumers seem to perceive experts as more united about the risk factors as health risks than experts do themselves. The findings are discussed with reference to the stigma concept and to a social constructionist perspective. The results contribute to the understanding of consumer perception of risks and their understanding of expert agreement about health risks. They also point to the importance of the interplay between consumers and experts in the public debate and communication process about food and risks.     

Chancen und Herausforderungen der Rückversicherung in der gesetzlichen Krankenversicherung

In 2009 a so-called morbidity orientated risk structure equalization scheme was installed for the German statutory health insurance in order to minimize structural differences between different providers with respect to revenue and expenditures. Even with this mechanism some risks to the individual health insurance providers remain. Reinsurance could be a way to mitigate these risks, but so far only very few contracts have been signed. Moreover the existing reinsurance contracts only focus on the periphery of the statutory health insurance system such as travel health insurance. In this article we therefore analyse existing risks for individual health insurance providers and evaluate their (re-)insurability. Hereafter the potential for reinsurance solutions in the German statutory health insurance itself as well as in newer forms of healthcare provision (e.g. integrated health care and managed care) is discussed. We find that reinsurance may be a reasonable solution for many of the risks in the statutory health insurance scheme. But as research in this area is very young further analysis of the nature of risks is necessary.     

Book Review

This research examines two modes of assessment of environmental health risks and the transformation of these risks into public health issues while relying on the specific case of well‐water toxicity and mega dose of electromagnetic radiation found in one prosperous town in the center of Israel – Ramat ha‐Sharon. Based on official and scientific documentation and interviews conducted at three time periods with randomly selected town residents from contaminated neighborhoods (N = 169), this study shows the discrepancy between the ‘objective’ experts’ standards for assessing environmental health risks and the public’s subjective perception and evaluation of the impact of these risks on their health and well‐being. Even though, by experts’ standards, the well‐water toxicity remained constant over the three interview sessions, Ramat ha‐Sharon town residents’ subjective levels of concern and perception of risk fluctuated as a function of news media and municipality announcements and residents’ perceived ability to minimize the risk. This study also shows the complex and multidisciplinary nature of environmental health risk assessments and the need to relocate them into the broader socioeconomic and political context in which they are embedded.     

Subsidization and Choice in the Group Health Insurance Market

This study investigates the effect of group health insurance plan choice on insurance unit price. The empirical findings suggest that the unit price of insurance, as measured by the ratio of the premium to expected indemnity benefits, is lower in group plans that offer employees a choice of different insurance options and require a premium contribution than it is in plans lacking at least one of these two features. The analyses suggest that lower unit prices are related to an increase in indemnity benefits and that the reduction in the unit price is greater for lower risks. The findings indicate that although subsidization of high risks by low risks occurs with group health insurance, the degree of subsidization is less when employees are offered a choice of health insurance plans.     

Shifting reactions to risks: a case study

Social science research in the field of risk analysis has emphasised evaluating the magnitude of individuals’ reactions to risks (e.g. strength and salience of concerns, frequency and forcefulness of behaviours that respond to risks). Fewer studies assess the factors that contribute to risk reactions or the types of risks to which reactions are directed (e.g. human health, wildlife health or ecosystem health risks; economic or aesthetic concerns). Theoretical and empirical research on amplification and attenuation of risk (e.g. the Social Amplification of Risk Framework) reveals that the strength of people’s reaction to risks can change markedly over time, as a function of new stimuli. We expand on this foundation to consider here how the types of risks members of the public react to may also shift over the course of their exposure to a hazard, particularly as more information about the hazard becomes available. This case study of risk reactions related to an outbreak of type E botulism in north-western Michigan, USA, demonstrates that the types of risks people react to can change substantially over time. We identify factors that contributed to changes in types of risk reactions, and then consider how these factors potentially distinguish the botulism outbreak from other outbreaks. This case study suggests that, under certain conditions, risk communication can meaningfully alter the types of risks that people react to in response to an environmental hazard. We discuss implications of these findings for risk research, risk communication and environmental conservation.     

Perceived risk and value of workplace safety in a developing country

We examine the relationship between wages and perceived occupational health risks for petrochemical workers in Taiwan. We estimate hedonic wage functions to compare workers' wages to their perceived risks of fatal and disabling accidents. The results indicate that workers in risky jobs receive a compensating wage differential, after controlling for education, job tenure, and occupational classification. The values of mitigating health risks are estimated using models that control for both fatal and nonfatal accident risks, and so do not suffer the omitted-variable bias characteristic of most earlier studies. The estimated values of statistical life and disabling injury are US$624 000 and US$44 000 in 1995 dollars. We also find a positive relationship between quitting intentions and perceived job risk, which supports the hypothesis that workers' risk perceptions evolve with on-the-job experience.     

Self-determination and risk: the role of life goals and causality orientation in domain-specific risk propensity

A growing body of risk research shows that risk is content specific. Accordingly, various studies have highlighted some factors that could explain why people’s risk propensity may arise in certain domains of risk (e.g. the financial domain) but not in other domains (e.g. the recreational domain). Until now, no research has examined motivation as a possible correlate of domain-specific risk propensity. On the basis of self-determination theory (SDT), we examined the role of both extrinsic life goals (i.e. superficial goal striving, including fame, money, and physical attraction) and control-orientated personality style (i.e. feeling that one’s behaviors are governed by external contingencies) in the propensity to take risks in various domains (social, ethical, recreational, financial, and health/safety). A community sample of 197 participants completed measures scaled to assess extrinsic life goals, controlled orientation, and domain-specific propensity (DOSPERT). The results showed that pursuing extrinsic goals and being control oriented increased the propensity to take ethical, recreational, financial, and health/safety risks but decreased the propensity to take social risks. In addition, to corroborate that risk propensity is domain specific, these results indicate that superficial life aspiration and sensitivity to social pressures are highly predictive of instrumental risks (e.g. ethical and financial), moderately predictive of health risks, and negatively predictive of ego-threatening risks (e.g. social risk). The results are discussed in light of the domain-specific risk literature and in the perspective of interventions based on SDT.     

Genetic risk and value

A conceptual truth about risks is that they involve a possible and future adverse effect or a negative value of some kind. The genetic risks that individuals may face in the health care setting differ in some crucial respects to other kind of risks. The aims of this paper are to analyse the notion of value in the context of genetic risk in the setting of health care, and to suggest a conception of the evaluative aspect of genetic risk that is fruitful for genetic risk information. Two influential and relevant approaches to value, preferentialism and the capability approach, are discussed in the light of certain distinctive features of genetic risk and a third, a sensibility theory of value is suggested. According to this view, the concept of risk is a so-called ‘thick’ evaluative concept that has both a world-guiding function as well as an action-guiding or normative function. It is argued that this provides a more promising way to think about genetic risks in the clinical setting.     

Mobile phone masts,social rationalities and risk: negotiating lay perspectives on technological hazards

This paper examines the responses of 37 participants in six focus groups to media representations of the health risks associated with mobile phone masts (‘base stations’) in the light of theoretical debates concerning non‐expert understandings of risks (variously characterised as ‘lay rationality’, lay epidemiology’, popular epidemiology’, ‘public knowledges’, ‘social rationality’ and ‘intuitive risk judgements’). In particular, the study discusses the extent to which two particular manifestations of such understandings – non‐mediated contextual and personal knowledges (‘multiple information sources’), and risk comparisons made between mobile phone masts and a variety of other perceived health risks – are prominent in respondents’ discursive constructions of risk. The paper suggests that analyses of risk responses such as these should differentiate clearly between classes of risks, and avoid suggestions that any particular type of risk response can be unproblematically mapped onto other risk scenarios.     

Examining inequities in children’s environmental health: results of a survey on the risk perceptions and protective actions of new mothers

Young children are more highly exposed and vulnerable to environmental health hazards than adults due to a variety of physiological and behavioural factors. Despite the significant responsibility mothers typically bear in managing their children’s health, little is known about how they perceive and negotiate these risks in their day-to-day lives. To better understand mothers’ environmental health risk perceptions and associated protective actions across socio-economic and geographic contexts, a telephone survey was conducted among new mothers (n = 606) recruited through two Public Health Units in Ontario, Canada. Analyses revealed that approximately half of the respondents were moderately or highly concerned about environmental health risks, ranging in nature from household products to outdoor air contaminants. Factors affecting the likelihood of experiencing concern included lower income and lower levels of perceived control. With regard to protective actions, 43% reported taking three or more actions to reduce environmental health risks to their children, with the likelihood of taking action being negatively affected by factors including low income and first language other than English or French, and positively affected by being a first-time parent (primiparous). This study contributes to our understanding of environmental health risk perceptions and associated protective behaviours among new mothers, and has implications for the development of more context-focused risk management and communication strategies.     

Biomedical risks and citizenship: depoliticizing cell site deployment in the Netherlands and Southern California

Cell phone technology has become a ubiquitous quasi-utility worldwide. Meanwhile, controversies around its health risks are continually emerging in locations around the world. In this paper, we argue that the ongoing controversy is primarily the effect of practices that are trying to govern cell site risks, rather than inherent uncertainties or qualities of the technology. We understand this as a process of medicalization that engenders bio-citizenship. We extend bio-citizenship theory by exposing how actors show an astute and reflexive awareness of the mobilizing potential of medicalization.

We study the governance practice of cell site deployment in the Netherlands and Southern California, USA and investigate how the risk issues and citizenship concerning cell site deployment are co-produced in four main governance practices. Network roll-out practices move health risks backstage, prevention practices push health risks and uncertainties into the future. Design practices actively avoid cell site risks, whereas care practices contain them. Government and industry have become aware of the contentious effect of cell site deployment and govern this to protect the roll-out of the technology. We call this depoliticization. Depoliticization can unintendedly open up new avenues for citizen mobilization.     

Policy Making on Reserves of Dutch University Hospitals: A Case Study

Organizations in the health care sector are increasingly managed and judged on the basis of economic criteria. Because they are faced with growing risks, reserves need to be sufficiently high. This paper entails a case study on policy making regarding reserves in a particular segment of the Dutch health care sector, i.e. university hospitals. After describing the various major risks of health care organizations, the three stages of the case study will be presented. First, we developed, in collaboration with experts from the university hospitals, a model for establishing sufficient reserves. Second, an advisory committee of the Dutch government formulated guidelines for policy making on this issue. Finally, after the recommendations of this committee became the basis for policy making on reserves, we examined the changes in the actual reserve policy of the university hospitals. The way in which health care organizations can cope with their perceived risks by establishing sufficient reserves or by taking other actions is hardly covered in the literature on public sector or not–for–profit organizations. This paper endeavours to raise relevant questions and to suggest preliminary answers by describing and critically appraising a case study on this subject.     

背景风险对保险需求的影响——基于中国健康保险市场的实证研究

保险需求理论研究表明,不可保的背景风险会增加投保人对可保风险的保险需求。本文把2003年发生的SARS看作一次自然实验,来检验背景风险对保险需求的影响。本文用我国健康保险市场的时间序列数据,通过邹-检验和时间序列结构突变检验方法,对存在背景风险时的保险需求理论进行实证研究。研究发现,背景风险会增加投保人对可保风险的保险需求,但这种影响只具有短期效应。     

Self‐Funding of Health‐Care Plans by Small Firms: Risks and Reforms

Small employers that offer health insurance have usually offered fully insured products through traditional health plans. Recently, the Patient Protection and Affordable Care Act (ACA) has created new requirements for fully insured products that will entice more small firms to fund their own health‐care benefits. However, self‐funding poses significant risks to these small firms, their employees, and state exchanges. To mitigate some of these risks within current political realities, we recommend advance disclosures—to small firms of material changes in their stop‐loss policies, and to their employees that premium subsidies are available only on ACA exchanges. We also suggest strengthening Small Business Health Options Program exchanges by broadening the availability of subsidies and building partnerships with brokers. Finally, we recommend an expanded role for brokers and third‐party administrators in helping small firms improve their choice of health‐care insurance.     

Risk communication in dementia care: family perspectives

Family carers are often involved in decisions concerning the health and social care needs of people with dementia. These decisions frequently involve considering risks inherent in daily living situations and discussing these with care recipients and professionals. The purpose of this study is to understand the risks that present most concern to family carers; explore attitudes and approaches of this group towards risk; and examine how information about risks is shared between familial carers, care recipients and professionals working in dementia care. Five focus groups were held across Northern Ireland between April and July 2015 involving 22 carers. Risks of most concern were driving, falls, financial risks, getting lost and using electrical appliances. Concepts of ‘risk’ related to terms such as danger, harm and vulnerability with emphasis on consequences rather than likelihoods. The psychosocial benefits of taking risk were recognised by some participants. Discussion of risks with family members with dementia primarily involved bringing risk matters to the attention of the individual. Family carers talked with a wide range of professionals about risks. Divergences in perspectives were noted, particularly in relation to matters of health and safety. A model of risk communication is developed illustrating how this can play a key role in informed, shared decision-making where a family member has dementia, serving an important role in risk management processes in informal community dementia care.     

Managing the demand for health services by adopting patient-centered programs

Recently, the trend to managing the demand of health care services has become more prevalent. Standalone types of demand management programs are patient-centered and support appropriate health care decision making by the consumer. The author examines these types of programs including their benefits and risks.     

Engaging employees in health care can contain costs and improve quality

Employers need to do much more to change some of the deep-seated employee attitudes and behaviors that are driving health care costs. This article debunks common employer misconceptions about employees' attitudes and behaviors with regard to health care. It then discusses the results employers can obtain by taking specific initiatives that provide employees with the motivation and resources they need to effectively manage health risks and make informed health care decisions.