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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Related in: MedlinePlus

Example of change in Utilities
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Figure 5: Example of change in Utilities

Mentions: Another mechanism for a change in the allocations is a change in the utility functions of the actors. Such a change eventually leads to a new Pareto frontier, thus enabling Pareto movement to the new frontier. For example: a change in the utility of Actor II in Figure 5 shifts the original Pareto frontier upward into the modified Pareto frontier. This shift provides opportunity of a shift from the "A" and "B" equilibrium points on the original Pareto frontier to any point on the "A1" to "B1" curved sections on the modified Pareto frontier. Because much of the positioning of the actors in the healthcare market is due to public expectations, change in these expectations may lead to changes in the utilities and thus to a change in the Pareto frontier. The change in the attitude toward obesity, for example, is responsible for major shifts in the positioning of various treatments, diets, medications and behaviors.


Balancing influence between actors in healthcare decision making.

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

Example of change in Utilities
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Example of change in Utilities
Mentions: Another mechanism for a change in the allocations is a change in the utility functions of the actors. Such a change eventually leads to a new Pareto frontier, thus enabling Pareto movement to the new frontier. For example: a change in the utility of Actor II in Figure 5 shifts the original Pareto frontier upward into the modified Pareto frontier. This shift provides opportunity of a shift from the "A" and "B" equilibrium points on the original Pareto frontier to any point on the "A1" to "B1" curved sections on the modified Pareto frontier. Because much of the positioning of the actors in the healthcare market is due to public expectations, change in these expectations may lead to changes in the utilities and thus to a change in the Pareto frontier. The change in the attitude toward obesity, for example, is responsible for major shifts in the positioning of various treatments, diets, medications and behaviors.

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