Ensuring Fairness in Health Care Coverage : An Employer's Guide to Making Good Decisions on Tough Issues

By (author) Wynia, Matthew K

"Choosing a health care plan that is both ethically sound and financially prudent is one of the biggest challenges facing businesses today. Many people think that high-quality, compassionate health care plans are prohibitively expensive. But in reality, purely cost-driven decisions end up costing businesses more in the long run. Fair health care coverage decisions are actually good for business! Studies show that employees who see their benefits as fair are more likely to stay with their employer, be more productive, and refrain from legal action. Fairness is the best policy - but employers are uncertain how to reconcile doing what is right with doing what is cost-effective. "Ensuring Fairness in Health Care Coverage" provides employers with a solid ethical framework for making even the most challenging benefits decisions. Based on a study by the Ethical Force Program, led by the Institute for Ethics at the American Medical Association, this book enables employers to make difficult decisions about the fairness - and perceived fairness - of the health benefits they provide, such as: whether to provide benefits to domestic partners; whether to give lower coverage for mental than for physical illnesses; whether to charge employees who smoke or who are obese more for health care coverage; how to differentiate between the various types of health care coverage - from HMOs to Health Savings Accounts - and how to determine which will benefit the most employees; and whether to index employee contributions to their salaries, with higher-paid employees paying more for the same benefits. This groundbreaking book provides five ethical guideposts to help employers make such decisions. The guideposts were developed by the Ethical Force Program's extensive interviews with a national expert advisory board representing the perspectives of all major participants in the health care system, including employers, insurance companies, physicians, patients, and regulators, followed by focus groups to further refine the principles. As this book explains, fair decision making should be: transparent - being completely open and honest about what decisions are made and why; Participatory - including employees in the decision process Sensitive to value - providing coverage that is both efficient and effective; Consistent - avoiding favoritism; and Compassionate - offering flexibility for special circumstances. Authors Matthew Wynia and Abraham Schwab show how to apply these guideposts to practical dilemmas employers face every day. Using real-world examples from their extensive research, they bring the principles to life and provide concrete steps for taking action on sensitive and complex issues. Their analyses of case examples, showing how employers have dealt with specific problems, are particularly enlightening. Creative and compassionate, "Ensuring Fairness in Health Care Coverage" will help employers design and administer plans for the benefit of their employees and their businesses."

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[目次]

  • "Foreword vii Acknowledgments xi Part I: The Issues and Principles of Fair Health Care Decisions Chapter 1 What's Fair? An Introduction to Fairness Issues 3 Foundations 5 Audience 7 Form and Function 8 The Stages of Health Care Coverage Decisions 9 Where to Apply the Five Ethical Guideposts 11 Legal Ramifications 13 The Ethical Guideposts Reflect Overlapping Ethical Principles 13 Next Steps 15 Chapter 2 Why Worry? The Business Case for Fair Decisions 16 The Five Ethical Guideposts for Making Fair Decisions 23 The Business Case 26 Two-Step Decisions 29 Abuse or Misuse of the Ethical Guideposts 30 "Give Him an Inch and He'll Take a Mile": The Importance of Balancing the Ethical Guideposts 32 Will the Guideposts Really Work? 33 Conclusion 36 Chapter 3 Why Is Health Insurance for Employees My Problem, Anyway? A Brief History of Health Insurance Coverage in the United States 38 Health Insurance in the United States 42 Tensions Within Managed Care 48 The Ethical Role of Businesses in Providing Health Insurance Coverage 52 The Basic Terminology of Health Insurance Coverage 54 Part II: The Five Ethical Guideposts of Fair Decision-Making Chapter 4 A Clear Choice: The Decision-Making Process Should Be Transparent 63 Why Transparency Is Important 65 Transparency Is Critical in Times of Transition 67 Transparency and Communication Barriers 71 Why Wouldn't an Employer Be Transparent? 72 Maximizing the Transparency of Your Decision-Making 73 What's the Business Case for Transparency? 75 Transparency as the Foundation of Fairness 76 Case Studies 78 [bpConclusion 90 Chapter 5 Get It Together: The Decision-Making Process Should Be Participatory 92 Improving Decision-Making Through Employee Participation 94 The Business Case for Employee Participation 97 Offering Employees the Opportunity to Participate 100 Why Wouldn't an Employer Be Participatory? 102 Case Studies 105 Conclusion 110 Chapter 6 You Can Count On It: The Decision-Making Process Should Be Consistent 111 Why Wouldn't an Employer Be Consistent? 114 What's the Business Case for Consistent Decision-Making? 117 Case Studies 118 Conclusion 129 Chapter 7 The Value Equation: The Decision-Making Process Should Be Sensitive to Value 131 Judgments of Value 134 Centers of Excellent Value 139 Determination of What? By Whom? 140 Why Wouldn't an Employer Be Sensitive to Value? 142 Case Studies 143 Conclusion 149 Chapter 8 Stay Flexible: The Decision-Making Process Should Be Compassionate 150 Types of Compassion 153 What Is the Business Case for Compassion? 156 Measuring and Balancing Compassion 157 Why Wouldn't an Employer Be Compassionate? 157 Case Studies 159 Conclusion 164 Chapter 9 Putting It All Together: Ensuring Fair Decisions 165 The Five Ethical Guideposts of Fair Decisions 167 Summarizing the Business Case (Once More, with Feeling) 172 Consistent, but Not Transparent? 174 Using Resources like HEDIS
  • rm, and Knowing Your Limits 175 Conclusion 175 Afterword 177 Appendix A: The Expert Advisory Panel on Benefits Determination 183 Appendix B: Steering by the Rearview Mirror: Factors That Shape Employee Health Plans 185 Appendix C: Selected Resources 213 Index 221 About the Authors 226"

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この本の情報

書名 Ensuring Fairness in Health Care Coverage : An Employer's Guide to Making Good Decisions on Tough Issues
著作者等 Wynia, Matthew K
書名別名 An Employer's Guide to Making Good Decisions on Tough Issues
出版元 Amacom
刊行年月 2006.10.01
ページ数 240p
大きさ H235 x W163
ISBN 9780814473849
言語 英語
出版国 アメリカ合衆国
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