Assuntos
Seguro Saúde , Cobertura Universal do Seguro de Saúde , Gastos em Saúde , Humanos , Seguro Saúde/legislação & jurisprudência , Assistência Centrada no Paciente , Política , Mecanismo de Reembolso , Estados Unidos , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/ética , Cobertura Universal do Seguro de Saúde/legislação & jurisprudênciaRESUMO
Large and mid-size employers are "between a rock and hard place" when it comes to health benefits: They are both unable to manage their health care costs effectively or simply get out of offering these benefits entirely. Although there is considerable diversity in how employers approach health care, several goals underlie most of their decisions. It is unlikely that the current round of employer-based health initiatives will succeed at managing rising costs. As a result, employers are likely to become more interested than at any time in the past decade in exiting their roles as providers of health benefits.
Assuntos
Controle de Custos/métodos , Custos de Saúde para o Empregador/tendências , Planos de Assistência de Saúde para Empregados/tendências , Custo Compartilhado de Seguro , Gerenciamento Clínico , Planos de Assistência de Saúde para Empregados/economia , Promoção da Saúde , Humanos , Poupança para Cobertura de Despesas Médicas , Inovação Organizacional , Aposentadoria/economia , Estados UnidosAssuntos
Pesquisa sobre Serviços de Saúde , Avaliação de Programas e Projetos de Saúde , Garantia da Qualidade dos Cuidados de Saúde/economia , Reembolso de Incentivo , Humanos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Estados Unidos , United States Agency for Healthcare Research and QualityRESUMO
Employers will continue to have a key role in the U.S. health system. Unfortunately, their purchasing practices have fallen far short of ideal. Large employers can lead the way for smaller companies, but by not routinely using competitive bidding or integrating quality into their specifications, they have sent mixed messages to both health plans and providers. Employers need to either get serious about buying health care as individual companies or explore other options. To purchase effectively, both health care expertise and the sustained commitment of senior leadership are needed. Whether employers can reverse their historical performance and become better purchasers is an open question.
Assuntos
Comércio , Planos de Assistência de Saúde para Empregados/organização & administração , Serviços de Saúde/economia , Humanos , Setor Privado , Estados UnidosRESUMO
A number of large employers and public purchasers founded the Leapfrog Group in 2000 in an attempt to consolidate the purchaser voice and engage consumers and clinicians in improving health care quality. Drawing on evidence-based medicine, Leapfrog publicly releases information about the extent to which hospitals are adopting three safety "leaps" with the theoretical capacity to prevent thousands of deaths. Although the group has grown rapidly and achieved national recognition, employer-based initiatives historically have struggled to create changes in health care. This paper examines the impact of the Leapfrog Group and its efforts to address the challenges of employer initiatives.
Assuntos
Coalizão em Cuidados de Saúde , Setor de Assistência à Saúde , Humanos , Erros Médicos/prevenção & controle , Gestão da Segurança , Estados UnidosAssuntos
Participação da Comunidade , Revelação , Planos de Assistência de Saúde para Empregados/normas , Médicos/normas , Garantia da Qualidade dos Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde , Benchmarking , Centers for Medicare and Medicaid Services, U.S. , Medicina Baseada em Evidências , Planos de Assistência de Saúde para Empregados/economia , Humanos , Médicos/economia , Garantia da Qualidade dos Cuidados de Saúde/economia , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/normas , Autocuidado/economia , Estados UnidosRESUMO
BACKGROUND: Performance measures and reporting have not been adopted throughout the US health care system despite their central role in encouraging increased participation by consumers in decision-making. Understanding whether the failure of measurement and reporting to diffuse throughout the health system can be overcome is critical for determining future policy in this area. OBJECTIVES: To create a conceptual framework for analyzing the current rate of adoption and evaluating alternatives for accelerating adoption, and to recommend a set of concrete steps that can be taken to increase the use of performance measurement and reporting. RESEARCH DESIGN: Review of three theoretic models (Rogers, Prochaska/DiClemente, Gladwell), examination of the literature on previous experiences with quality measurement and reporting, and interviews with select stakeholders. FINDINGS: The three theoretic models provide a valuable framework for understanding why the use of performance measures is stalled ("the circle of unaccountability") and for generating ideas about concrete steps that could be taken to accelerate adoption. Six steps are recommended: (1) raise public awareness, (2) redesign measures and reports, (3) make the delivery of information timely, (4) require public reporting, (5) develop and implement systems to reward quality, and (6) actively court leaders. CONCLUSIONS: The recommended six steps are interconnected; action on all will be required to drive significant acceleration in rates of adoption of performance measurement and reporting. Leadership and coordination are necessary to ensure these steps are taken and that they work in concert with one another.