Assuring value in medical care for employees and dependents: an opportunity for occupational physicians

Article Abstract:

This is one of a series of articles appearing in the December 1990 issue of the Journal of Occupational Medicine that discusses occupational physicians' changing roles in health resource management. Here, an argument is made that occupational physicians are ideally situated to become leaders in assuring that employees and their dependents receive medical care of value. This, rather than ''health care cost containment'' (a phrase commonly used by corporations), is the proper goal of physicians as they join with others to limit the rise in health care costs. Virtually everyone involved - employers, employees, and care providers - agrees that better care would also be cheaper care, given the apparent current excess of medical procedures being performed. Physician involvement can also steer corporate policy toward rewarding physicians who take responsibility for maintaining excellent practice standards, rather than depending on surveillance-oriented approaches, such as those that require second surgical opinions or precertification. Under such a plan, physician groups that deliver high-quality, cost-effective care would be rewarded by the referral of more patients. Everyone would benefit, and costs would be reduced further by matching patients appropriately with the level of care they need. Presently, corporations steer patients to particular kinds of care through economic incentives (or disincentives); better awareness of quality would provide other, more significant, incentives. Both corporations and employees need physician input of solid medical advice and support, as well as the provision of leadership for occupational and corporate health care management. Will practitioners of occupational medicine rise to the occasion? Filling such roles may require changes in the ways occupational medicine physicians perceive themselves and their position in the medical community. At the same time, physicians without a background in occupational medicine who want to become involved in planning employee health care need to learn the basics of the specialty. (Consumer Summary produced by Reliance Medical Information, Inc.)

Planning, Employment

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Assuring value in medical care for employees and dependents: Part II

Article Abstract:

The rising costs of health care have caused many companies to reevaluate and, in some cases, reduce the health benefit plans provided to their employees. This means that private payers will have to balance the cost and value of health care. Methods that have been used to accomplish this goal include indemnity insurance plan changes, prepaid health care, providing health care at the work site, and preventative medicine. This issue of the Journal of Occupational Medicine is devoted to the evaluation of strategies that can be and are being used to assure value in health care for employees and their dependents. Data management systems can be used to determine the health of the work force and the quality and cost-effectiveness of the health care program. Health maintenance organizations (HMOs) are being used to provide health care from within the health care system. Managing mental health benefits and care provides a real challenge because mental health patients consume a large fraction of the total resources allocated for health care. Preventative services are becoming more popular as a means of reducing health care costs. Programs designed to promote employee health and preventative medicine are being used to reduce the need for medical care. Many companies are starting to develop their own in-house health care programs that will reduce the need for purchasing external medical services. When medical services are purchased, the purchasers should work with the health care providers to determine the specific services that are needed. These strategies will help to improve the quality and reduce the cost of health care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Medical economics, Demographic aspects, Medical care, Cost of, Health care costs, Employee benefits, Cost shifting (Medical care)

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Assuring value in medical care for employees and dependents

Article Abstract:

A series of articles in the December 1990 issue of the Journal of Occupational Medicine presents different viewpoints concerning occupational physicians' changing roles in health resource management. In this introductory article, brief summaries of the articles are presented, and the context of the series is explained. The proportion of the health care dollar that is paid by companies has risen dramatically in the last few years - from under 30 percent in 1986 to a predicted 40 percent in 1990. As a result, companies want to contain medical costs. Physicians, on the other hand, often stress ''quality'', which can be interpreted to mean, simply, ''lots of medical care''. Occupational physicians need to be involved in the restructuring of health care management, and they should strive to optimize results for the entire organization to which they belong. They should also retain an awareness of their commitments to patients and to ethics, and promote prevention whenever possible. The seven sections in the Journal issue cover the following topics: perspectives on quality and value; the role of the corporate medical department; measurement of effectiveness and efficiency; physician decision-making; support for consumer decision-making; the economic environment of medical care; and a review of resources useful to readers. A companion issue to this one will be published in March 1991. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice, Social policy, Beliefs, opinions and attitudes, Corporations

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