Limits...
Balancing influence between actors in healthcare decision making.

Kaplan RM, Babad YM - BMC Health Serv Res (2011)

Bottom Line: In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes.Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives.These actions include improved transparency of all aspects of medical decision making, greater involvement of patients in shared medical decision making, greater oversight of guideline development and coverage decisions, limitations on direct to consumer advertising, and the need for an enhanced role of the government as the public advocate.

View Article: PubMed Central - HTML - PubMed

Affiliation: Departments of Health Services and Medicine, University of California-Los Angeles, CA, USA. rmkaplan@ucla.edu

ABSTRACT

Background: Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues.

Discussion: A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors.

Summary: A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision making, greater involvement of patients in shared medical decision making, greater oversight of guideline development and coverage decisions, limitations on direct to consumer advertising, and the need for an enhanced role of the government as the public advocate.

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Life expectancy in selected developed countries, 2005 (OEDC data, art original)
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Figure 1: Life expectancy in selected developed countries, 2005 (OEDC data, art original)

Mentions: Several major issues, which are most evident in the United State (U.S.), must be addressed with regard to healthcare resources and their allocation. First, health outcomes in the U.S. are not outstanding relative to other developed economies, even though the U.S. healthcare expenditure per capita and as a percentage of GDP far exceed those of any other economies[2,3]. Among G8 countries, the U.S. has higher infant mortality and lower life expectancies than peer societies (Figure 1). Second, the U.S. has been unable to control healthcare costs. Although the rate of increase slowed down in the 1990s[4], evidence suggests a new acceleration in healthcare costs and that costs will continue to increase in the future[5]. The consequences of the inability to control costs are well known, and are among the major drivers for the current health reform. For example, American products do not compete well on the international market[6], and the rate of uninsured which appears to be linked to the costs of healthcare[7] continues to climb. Third, the distribution of health services and outcomes is highly variable, with wide differences in their distribution among various population groups.


Balancing influence between actors in healthcare decision making.

Kaplan RM, Babad YM - BMC Health Serv Res (2011)

Life expectancy in selected developed countries, 2005 (OEDC data, art original)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108374&req=5

Figure 1: Life expectancy in selected developed countries, 2005 (OEDC data, art original)
Mentions: Several major issues, which are most evident in the United State (U.S.), must be addressed with regard to healthcare resources and their allocation. First, health outcomes in the U.S. are not outstanding relative to other developed economies, even though the U.S. healthcare expenditure per capita and as a percentage of GDP far exceed those of any other economies[2,3]. Among G8 countries, the U.S. has higher infant mortality and lower life expectancies than peer societies (Figure 1). Second, the U.S. has been unable to control healthcare costs. Although the rate of increase slowed down in the 1990s[4], evidence suggests a new acceleration in healthcare costs and that costs will continue to increase in the future[5]. The consequences of the inability to control costs are well known, and are among the major drivers for the current health reform. For example, American products do not compete well on the international market[6], and the rate of uninsured which appears to be linked to the costs of healthcare[7] continues to climb. Third, the distribution of health services and outcomes is highly variable, with wide differences in their distribution among various population groups.

Bottom Line: In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes.Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives.These actions include improved transparency of all aspects of medical decision making, greater involvement of patients in shared medical decision making, greater oversight of guideline development and coverage decisions, limitations on direct to consumer advertising, and the need for an enhanced role of the government as the public advocate.

View Article: PubMed Central - HTML - PubMed

Affiliation: Departments of Health Services and Medicine, University of California-Los Angeles, CA, USA. rmkaplan@ucla.edu

ABSTRACT

Background: Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues.

Discussion: A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors.

Summary: A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision making, greater involvement of patients in shared medical decision making, greater oversight of guideline development and coverage decisions, limitations on direct to consumer advertising, and the need for an enhanced role of the government as the public advocate.

Show MeSH
Related in: MedlinePlus