Confronting Trade-Offs In Health Care: Harvard Pilgrim Health Care’s Organizational Ethics Program

2007 ◽  
Vol 26 (4) ◽  
pp. 1129-1134 ◽  
Author(s):  
James E. Sabin ◽  
David Cochran
Keyword(s):  
Health Care ◽  
Organizational Ethics ◽  
Trade Offs ◽  
Harvard Pilgrim Health ◽  
Ethics Program

Transitional Care:A Priority for Health Care Organizational Ethics

2016 ◽  
Vol 46 ◽  
pp. S39-S42 ◽  
Author(s):  
Mary Naylor ◽  
Nancy Berlinger
Keyword(s):  
Health Care ◽  
Organizational Ethics

scholarly journals Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

2020 ◽  
Author(s):  
Mais HM Iflaifel ◽  
Rosemary Lim ◽  
Kath M Ryan ◽  
Clare Crowley
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Safety Management ◽  
Hand Search ◽  
Trade Offs ◽  
Time Work ◽  
Management Paradigms ◽  
Resilience Training ◽  
Traditional Approaches ◽  
Standard Strategy

Abstract Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC is conceptualised, described and interpreted in the published literature, to describe the methods used to study RHC, and to identify factors that develop RHC. Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search undertaken for studies published in books that explained how RHC as a concept has been interpreted, what methods have been used to study it, and what factors have been important to its development. Studies were evaluated independently by two researchers. Data was synthesised using a deductive thematic approach. Results Twenty-six studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods were mainly used to study RHC. Two types of data sources have been used: direct (e.g. focus groups) and indirect (e.g. observations). Most of the tools for studying RHC were developed based on predefined resilient constructs and have been categorised into three categories: performance variability and Work As Done, cornerstone capabilities for resilience, and integration with other safety management paradigms. Tools for studying RHC currently exist but have yet to be fully implemented. Effective team relationships, trade-offs and health care ‘resilience’ training of health care professionals were factors used to develop RHC. Conclusions Although there was consistency in the conceptualisation of RHC, as well as in the methods used to study and the factors used to develop it, several questions remain to be answered before a gold standard strategy for studying RHC can confidently be identified. These include operationalising RHC assessment methods in multi-level and diverse settings and developing, testing and evaluating interventions to address the wider safety implications of RHC amidst organisational and institutional change.

scholarly journals Value-based provider payment: towards a theoretically preferred design

2018 ◽  
Vol 15 (1) ◽  
pp. 94-112 ◽  
Author(s):  
Daniëlle Cattel ◽  
Frank Eijkenaar ◽  
Frederik T. Schut
Keyword(s):  
Health Care ◽  
Pay For Performance ◽  
Empirical Studies ◽  
Risk Profile ◽  
Provider Group ◽  
Payment Incentives ◽  
Trade Offs ◽  
Provider Payment ◽  
Group 2 ◽  
The Relationship

AbstractWorldwide, policymakers and purchasers are exploring innovative provider payment strategies promoting value in health care, known as value-based payments (VBP). What is meant by ‘value’, however, is often unclear and the relationship between value and the payment design is not explicated. This paper aims at: (1) identifying value dimensions that are ideally stimulated by VBP and (2) constructing a framework of a theoretically preferred VBP design. Based on a synthesis of both theoretical and empirical studies on payment incentives, we conclude that VBP should consist of two components: a relatively large base payment that implicitly stimulates value and a relatively small payment that explicitly rewards measurable aspects of value (pay-for-performance). Being the largest component, the base payment design is essential, but often neglected when it comes to VBP reform. We explain that this base payment ideally (1) is paid to a multidisciplinary provider group (2) for a cohesive set of care activities for a predefined population, (3) is fixed, (4) is adjusted for the population’s risk profile and (5) includes risk-mitigating measures. Finally, some important trade-offs in the practical operationalisation of VBP are discussed.

A ROLE FOR CONJOINT ANALYSIS IN TECHNOLOGY ASSESSMENT IN HEALTH CARE?

1999 ◽  
Vol 15 (3) ◽  
pp. 443-457 ◽  
Author(s):  
Mandy Ryan
Keyword(s):  
Health Care ◽  
Conjoint Analysis ◽  
Technology Assessment ◽  
Assessment Instruments ◽  
Relative Importance ◽  
Services Research ◽  
Vitro Fertilization ◽  
Trade Offs ◽  
History Of

The aim of this paper is to demonstrate the use of conjoint analysis (CA) in health services research. Conjoint analysis is first explained, with emphasis on the history of the technique, followed by an explanation of how to carry out such a study and how the results from such a study can be used. The technique is demonstrated with reference to a study that looks at the benefits of in vitro fertilization. It is shown how CA can be used to estimate the relative importance of attributes, the trade-offs individuals make between these attributes, willingness to pay if cost is included as an attribute, and utility or benefit scores for different ways of providing a service. The paper then considers the potential advantages of CA over other, more commonly used benefit assessment instruments. Finally, there is discussion of the issues raised in the design and analysis of CA studies. It is concluded that these issues must be addressed before the technique becomes an established instrument for technology assessment.

Lessons to Be Learned from Harvard Pilgrim HMO's Fiscal Roller Coaster Ride

2000 ◽  
Vol 28 (3) ◽  
pp. 287-304 ◽  
Author(s):  
Frances H. Miller ◽  
Walter W. Miller
Keyword(s):  
Health Care ◽  
Roller Coaster ◽  
State Legislation ◽  
High Profile ◽  
Financial Difficulties ◽  
Competitive Environments ◽  
Harvard Pilgrim Health ◽  
History Of ◽  
Shed Light

The recent high-profile financial difficulties of Harvard Pilgrim Health Care, the largest HMO in Massachusetts and consistently rated as one of the top ten HMOs in the nation, shed light on many problems common to health insurers throughout the country. This article explores those difficulties in the context of the short but complicated history of Harvard Pilgrim, and its regulatory and competitive environments. The state legislation which made a receivership proceeding possible for Harvard Pilgrim offered some protection for subscribers, but failed to provide the means for achieving a long term solution. The statute merely presented a method for staving off immediate collapse by temporarily protecting the plan from dissolution, and forcing the plan's contracting providers to continue delivering care even if owed money by the plan. The article concludes by drawing lessons for understanding and ideally avoiding similar managed care nearfatalities in the future.

Measuring Public Preferences for Changes in the Health Insurance Benefit Package Policies in Iran: A Survey Approach

2020 ◽  
Author(s):  
Efat MOHAMADI ◽  
Alireza OLYAEEMANESH ◽  
Arash RASHIDIAN ◽  
Abbas RAHIMI FOROUSHANI ◽  
Ali HASSANZADEH ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Services ◽  
Health Sector ◽  
Sample Population ◽  
Benefit Package ◽  
Term Care ◽  
Public Preferences ◽  
Insurance Benefit ◽  
Trade Offs

Background: This study aimed to identify the public preference in health services, the principles that Iranian people consider important, and the aspects of trade-offs between different values in resource allocation practices. Methods: This quantitative study was conducted to investigate public preferences on Health Insurance Benefit Package (HIBP) in 2017. A structured questionnaire was used for data collection, including the preferences of the people who live in Tehran, were above 18 year, and were covered by basic insurance for the HIBP contents and premium. The sample size was calculated 430 subjects and SPSS Statistics was used for data analyzing. Results: 81.6% of the sample population agreed with government allocating more money to the health sector compared to other sectors and organizations and 55% were willing to pay higher premiums for expanding the HIBP coverage. The highest and lowest score regarding prioritization of budget allocation between health services was related to hospitalization services (28.6%) and rehabilitation services (1.6%), respectively. The first priority of respondents regarding health care and life cycle, was "prevention in newborns" (15.9%), the second priority was "prevention in children" (14.6%), the third priority was "prevention in adults" (9.5%), and the last priority was "short-term care in newborns" (0.9%). Conclusion: Iranian people believe that not only the principle of health maximization but also equal opportunities to access health care and a fair allocation of resources should be considered by authorities for effective health insurance policymaking. In this case, given the scarcity of resources, setting priorities for alternative resources is inevitable.

Mental Health Care Funding Systems and their Impact on Access to Psychotherapy

2020 ◽  
Author(s):  
Joelle Robertson-Preidler ◽  
Nikola Biller-Andorno ◽  
Tricia Johnson
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Distributive Justice ◽  
Health Systems ◽  
Health Care Systems ◽  
Resource Scarcity ◽  
Trade Offs ◽  
Health Care Funding ◽  
Care Systems

Resource scarcity forces health care systems to set priorities and navigate trade-offs in how they choose to fund different services. Distributive justice principles can help guide health systems to fairly allocate scarce resources in a society. In most countries, mental health care and psychotherapy, in particular, tend to be under-prioritized even though psychotherapy can be an effective treatment for mental health disorders. To create ethical funding systems that support appropriate access to psychotherapy, health care funding systems must consider how they allocate and distribute health care resources through health care financing, coverage criteria, and reimbursement mechanisms. Five health care systems are assessed according to how they finance and reimburse psychotherapy. These health systems use various and often pluralistic approaches that encompass differing distributive justice principles. Although distribution priorities and values may differ, fair and transparent processes that involve all key stakeholders are vital for making ethical decisions on access and distribution.

Covering It Up? Questions of Safety, Stigmatization, and Fairness in Covert Medication Administration

2017 ◽  
Vol 45 (2) ◽  
pp. 204-211
Author(s):  
Christy Simpson
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Organizations ◽  
Organizational Ethics ◽  
Medication Administration ◽  
Care Providers

This paper examines the practice of covert medication administration from an organizational ethics perspective. This includes consideration of vulnerability and stigmatization, safety, and fairness (justice) in terms of the culture of health care organizations and the relevance of policies and processes in relation to covert medication administration. As much of the discussion about covert medication administration focuses on patients and health care providers, this analysis aims to help expand the analysis of this practice.

Employment Change Among Married Parents of Children With Special Health Care Needs

2016 ◽  
Vol 38 (5) ◽  
pp. 579-606 ◽  
Author(s):  
LeaAnne DeRigne ◽  
Shirley L. Porterfield
Keyword(s):  
Health Care ◽  
Medical Expenditure Panel Survey ◽  
Special Health Care Needs ◽  
Medical Expenditure ◽  
Care Practice ◽  
Health Care Needs ◽  
Care Needs ◽  
Special Health Care ◽  
Trade Offs ◽  
Special Health

Over one in five households with children has at least one child with a special health care need (CSHCN). Child health caregiving can bleed into paid work time. This research analyzes what factors influence work decisions (who reduces work and by how much) in married-couple families with CSHCN. This article uses data from the Medical Expenditure Panel Survey to examine the specifics of changes in parental work status and a comparison of family/work trade-offs made by parents in families with and without a CSHCN. Results indicate that mothers are more likely to experience negative work changes than fathers. Both mothers and fathers with CSHCN are more likely to report missing work than parents of children without special health care needs. Overall, when children receive treatment in a primary care practice that serves as a medical home, parents are less likely to experience negative employment changes.

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