Tobacco Control 1994 i 3: 124-129 Smoking control policies in private health insurance in Califor... more Tobacco Control 1994 i 3: 124-129 Smoking control policies in private health insurance in California : results of a statewide survey School of Public Health, University of California, Berkeley, California 94720, USA HH Schauffler D Gentry Helen Halpin Schauffler, Daniel Gentry Abstract ...
... Prof. Schauffler would like to extend special thanks to Hattie Skubik Hanley. ... 1601 (1996)... more ... Prof. Schauffler would like to extend special thanks to Hattie Skubik Hanley. ... 1601 (1996) (discussing the substantive issues raised by the backlash against HMOs); Alain C. Enthoven & Sara J. Singer, The Managed Care Backlash and The Task Force in California, HEALTH AFF. ...
To test empirically a model for estimating the direct and indirect effects of different forms of ... more To test empirically a model for estimating the direct and indirect effects of different forms of cost-sharing on the utilization of recommended clinical preventive services. DATA SOURCES/SETTINGS: Stratified random sample of 10,872 employees, 18-64 years, who had belonged to their plan for at least one year, from seven large companies that were members of the Pacific Business Group on Health (PBGH) in 1994. The 1994 PBGH Health Plan Value Check Survey. 1994 PBGH data on requirements for employee out-of-pocket patient cost-sharing for 52 different health plans. Five equations were derived to estimate the direct and indirect effects of two forms of cost-sharing (copayments and coinsurance/deductibles) in two forms of managed care (HMOs and PPO/indemnity plans) on four clinical preventive services: mammography screening, cervical cancer screening, blood pressure screening, and preventive counseling. Probit models were used to estimate elasticities for the indirect and direct effects. B...
This study evaluates the use of risk factors for chronic disease as health status adjusters for M... more This study evaluates the use of risk factors for chronic disease as health status adjusters for Medicare's capitation formula, the average adjusted per capita costs (AAPCC). Risk factor data for the surviving members of the Framingham Study cohort who were examined in 1982-83 were merged with 100 percent Medicare payment data for 1984 and 1985, matching on Social Security number and sex. Seven different AAPCC models were estimated to assess the independent contributions of risk factors and measures of prior utilization and disability in increasing the explanatory power of AAPCC. The findings suggest that inclusion of risk factors for chronic disease as health status adjusters can improve substantially the predictive accuracy of AAPCC.
Lack of health insurance coverage has been shown to reduce use of some preventive services. Howev... more Lack of health insurance coverage has been shown to reduce use of some preventive services. However, even when care is free or fully covered by insurance, clinical preventive services are not used at recommended levels. This study investigates the impact of different levels of health insurance coverage (ranging from none, some, most, and all preventive services covered) on the use of recommended clinical preventive services for adult men and women. Logistic regression was used to estimate the effect of different levels of health insurance coverage for preventive care on the probability of receiving six different clinical preventive services including periodic health exam, blood pressure screening, cholesterol screening, Pap smear, clinical breast exam, and screening mammography, as well as all recommended services for a given age and gender group. The study sample of adults ages 18 to 64 is from the Centers for Disease Control's 1991 Behavioral Risk Factor Surveillance System (B...
This article proposes a framework for the study of the effects of market forces on health promoti... more This article proposes a framework for the study of the effects of market forces on health promotion and disease prevention (HP/ DP) in integrated delivery systems (IDSs). We describe the evolution of IDSs in the United States and review the limited research on the extent to which IDSs have integrated HP/DP. We propose a typology of HP/DP activities that provides a comprehensive model of the types of HP/DP services and functions that an IDSs may incorporate. Finally, we identify and discuss the major market stages through which IDSs are transitioning, and within each market stage we identify the major forces that may influence IDS decisions to incorporate HP/DP services.
The objective of this research was to determine whether patients who reported that their physicia... more The objective of this research was to determine whether patients who reported that their physician or other health care professional had discussed health education topics with them were more satisfied with their physician than were patients who reported they had not. Data were from the 1994 Health Plan Value Check conducted by the Pacific Business Group on Health (52% response rate). The study sample included 5066 employees ranging in age from 19 to 64 years and representing four large corporations and 21 health plans. This population was randomly sampled by company and health plan. Bivariate and multivariate analyses were used to assess the relationship between level of patient satisfaction with physician and reported discussion of health education topics with a physician or other health professional in the last 3 years. Patients who reported that their physician or other health care professional discussed at least one health education topic with them in the last 3 years were more ...
I review the history and politics of Medicare disease prevention policy and identify factors asso... more I review the history and politics of Medicare disease prevention policy and identify factors associated with the success or failure of legislative initiatives to add preventive services benefits to Medicare. Between 1965 and 1990, 453 bills for Medicare preventive services were introduced in the U.S. Congress, but not until 1980, after 350 bills had failed, was the first preventive service added to the Medicare program. Medicare currently pays for only four of the 44 preventive services recommended for the elderly by the U.S. Preventive Services Task Force (pneumococcal and hepatitis B vaccinations, Pap smears, and mammography). In addition, Congress has funded demonstration programs for the influenza vaccine and comprehensive preventive services. The preventive services added to Medicare reflect the bias of the biomedical model toward screening and immunizations. Counseling services have received the least legislative attention. Factors associated with successful enactment include ...
Studies of young, employed populations have established an association between risk factors for c... more Studies of young, employed populations have established an association between risk factors for cardiovascular disease and health care costs, but an association has never been demonstrated in an elderly population. For the surviving elderly cohort (63 to 93 years of age) of the Framingham Heart Study (n = 1,053), we estimated a model regressing Medicare reimbursements per beneficiary over two years (1984 and 1985) on the two-year probability of cardiovascular disease at Exam 17 (1982 or 1983), controlling for other risk factors and prior health services use. Using the coefficient for the two-year probability for cardiovascular disease, we estimated Medicare cost ratios and dollar values associated with elevated compared with nonelevated risk for 12 risk profiles for cardiovascular disease. The average level of risk for cardiovascular disease in the elderly is associated with Medicare claims costs that are 19% higher (95% confidence interval [CI] = 10%, 29%) than those for persons wi...
One of the most important factors affecting the use of preventive services is health insurance co... more One of the most important factors affecting the use of preventive services is health insurance coverage; however, until recently, most public and private health plans have explicitly excluded coverage of most preventive care. As a result, preventive services are used less frequently than recommended guidelines suggest, which contributes to the high incidence of preventable morbidity and mortality in the United States. Recent congressional efforts to enact national health care reform legislation present an important opportunity to analyze coverage for preventive services. This article presents the results of an analysis of the prevention benefits in 23 comprehensive health care reform bills introduced in 1991 during the first session of the 102nd Congress. I classified each bill by type (employer-based, single payer, managed competition, tax credit, and insurance market reform) and through a content analysis identified benefits for immunization, screening, and counseling services (in...
1. Am J Prev Med. 1994 Sep-Oct;10(5 Suppl):1-31. Health promotion and disease prevention in healt... more 1. Am J Prev Med. 1994 Sep-Oct;10(5 Suppl):1-31. Health promotion and disease prevention in health care reform. Schauffler HH, Faer M, Faulkner L, Shore K. Department of Social and Administrative Health Sciences, School ...
In summary, the managed care system we propose for preventive services is designed to limit the p... more In summary, the managed care system we propose for preventive services is designed to limit the potential for overcare under FFS payment and for undercare under capitation and comprehensive fixed fees. It bases payment on the provision of a complete set of preventive services, thus limiting the tendency of physicians to provide only the relatively high-profit services, such as screening tests, while neglecting the lower-profit services, such as counseling. It also allows primary care providers to outsource selected services to lower-cost providers, such as laboratories, health educators, and counselors, and community-based health promotion programs, thus encouraging greater efficiency. In addition, the proposed system funds both primary and high-risk preventive case management to ensure that individuals receive preventive services appropriate to their age, sex, and risk factors. Finally, the proposed system monitors the use of preventive services, relying on physician reminders to stimulate the appropriate provision of preventive care and denying payment for unauthorized care. Existing research suggests that none of the individual strategies for managed care can be expected to achieve all of the goals of managing and promoting the appropriate use of preventive services as defined by the U.S. Preventive Services Task Force (1989). To be most effective, we conclude that the strategies need to be coordinated and integrated into the current health care delivery practices of HMOs, PPOs, and point-of-service plans. In addition, the strategies require additional provider training in preventive care. With this support, the proposed model has the potential to improve quality, control costs, and increase the appropriate use of preventive care. While many of the individual components of the proposed managed care model have been evaluated for preventive services, a great deal more research is needed to evaluate the effect of combining these elements into a coordinated and comprehensive approach to managing preventive care. Research is also needed on workable ways to invite people not currently receiving medical care into the health care system to receive preventive care. To inform policy development, the impact of the proposed managed care model--both on preventive services utilization for specific screening, immunization, and counseling services, and on total health care costs and patient health status outcomes--needs to be evaluated.
There has been increasing interest in using patient satisfaction as an indicator of quality of ca... more There has been increasing interest in using patient satisfaction as an indicator of quality of care by the purchasers of health plans, as well as the basis for marketing by competing plans. Few studies have examined if availability and utilization of health promotion programs are associated with patient satisfaction with the health plan. Data from the Bay Area Business Group on Health 1992 Employee Medical Plan Satisfaction Survey were used to examine these relationships. The findings indicate that persons enrolled in staff-model health maintenance organizations are much more likely to be offered health promotion programs by their plan or physician compared with persons enrolled in independent practice association-model health maintenance organizations and indemnity plans. However, regardless of plan type, employees who have been offered stop-smoking programs, stress management programs, weight-control programs, cholesterol screening and blood pressure screening, or any health promotion program by their plan or physician are more satisfied with their health plan than whose who have not. In addition, employees who have participated in a health promotion program also are more satisfied than employees who have not participated in such a program. The findings have important implications for designing and restructuring health plans to better meet consumer preferences.
Tobacco Control 1994 i 3: 124-129 Smoking control policies in private health insurance in Califor... more Tobacco Control 1994 i 3: 124-129 Smoking control policies in private health insurance in California : results of a statewide survey School of Public Health, University of California, Berkeley, California 94720, USA HH Schauffler D Gentry Helen Halpin Schauffler, Daniel Gentry Abstract ...
... Prof. Schauffler would like to extend special thanks to Hattie Skubik Hanley. ... 1601 (1996)... more ... Prof. Schauffler would like to extend special thanks to Hattie Skubik Hanley. ... 1601 (1996) (discussing the substantive issues raised by the backlash against HMOs); Alain C. Enthoven & Sara J. Singer, The Managed Care Backlash and The Task Force in California, HEALTH AFF. ...
To test empirically a model for estimating the direct and indirect effects of different forms of ... more To test empirically a model for estimating the direct and indirect effects of different forms of cost-sharing on the utilization of recommended clinical preventive services. DATA SOURCES/SETTINGS: Stratified random sample of 10,872 employees, 18-64 years, who had belonged to their plan for at least one year, from seven large companies that were members of the Pacific Business Group on Health (PBGH) in 1994. The 1994 PBGH Health Plan Value Check Survey. 1994 PBGH data on requirements for employee out-of-pocket patient cost-sharing for 52 different health plans. Five equations were derived to estimate the direct and indirect effects of two forms of cost-sharing (copayments and coinsurance/deductibles) in two forms of managed care (HMOs and PPO/indemnity plans) on four clinical preventive services: mammography screening, cervical cancer screening, blood pressure screening, and preventive counseling. Probit models were used to estimate elasticities for the indirect and direct effects. B...
This study evaluates the use of risk factors for chronic disease as health status adjusters for M... more This study evaluates the use of risk factors for chronic disease as health status adjusters for Medicare's capitation formula, the average adjusted per capita costs (AAPCC). Risk factor data for the surviving members of the Framingham Study cohort who were examined in 1982-83 were merged with 100 percent Medicare payment data for 1984 and 1985, matching on Social Security number and sex. Seven different AAPCC models were estimated to assess the independent contributions of risk factors and measures of prior utilization and disability in increasing the explanatory power of AAPCC. The findings suggest that inclusion of risk factors for chronic disease as health status adjusters can improve substantially the predictive accuracy of AAPCC.
Lack of health insurance coverage has been shown to reduce use of some preventive services. Howev... more Lack of health insurance coverage has been shown to reduce use of some preventive services. However, even when care is free or fully covered by insurance, clinical preventive services are not used at recommended levels. This study investigates the impact of different levels of health insurance coverage (ranging from none, some, most, and all preventive services covered) on the use of recommended clinical preventive services for adult men and women. Logistic regression was used to estimate the effect of different levels of health insurance coverage for preventive care on the probability of receiving six different clinical preventive services including periodic health exam, blood pressure screening, cholesterol screening, Pap smear, clinical breast exam, and screening mammography, as well as all recommended services for a given age and gender group. The study sample of adults ages 18 to 64 is from the Centers for Disease Control's 1991 Behavioral Risk Factor Surveillance System (B...
This article proposes a framework for the study of the effects of market forces on health promoti... more This article proposes a framework for the study of the effects of market forces on health promotion and disease prevention (HP/ DP) in integrated delivery systems (IDSs). We describe the evolution of IDSs in the United States and review the limited research on the extent to which IDSs have integrated HP/DP. We propose a typology of HP/DP activities that provides a comprehensive model of the types of HP/DP services and functions that an IDSs may incorporate. Finally, we identify and discuss the major market stages through which IDSs are transitioning, and within each market stage we identify the major forces that may influence IDS decisions to incorporate HP/DP services.
The objective of this research was to determine whether patients who reported that their physicia... more The objective of this research was to determine whether patients who reported that their physician or other health care professional had discussed health education topics with them were more satisfied with their physician than were patients who reported they had not. Data were from the 1994 Health Plan Value Check conducted by the Pacific Business Group on Health (52% response rate). The study sample included 5066 employees ranging in age from 19 to 64 years and representing four large corporations and 21 health plans. This population was randomly sampled by company and health plan. Bivariate and multivariate analyses were used to assess the relationship between level of patient satisfaction with physician and reported discussion of health education topics with a physician or other health professional in the last 3 years. Patients who reported that their physician or other health care professional discussed at least one health education topic with them in the last 3 years were more ...
I review the history and politics of Medicare disease prevention policy and identify factors asso... more I review the history and politics of Medicare disease prevention policy and identify factors associated with the success or failure of legislative initiatives to add preventive services benefits to Medicare. Between 1965 and 1990, 453 bills for Medicare preventive services were introduced in the U.S. Congress, but not until 1980, after 350 bills had failed, was the first preventive service added to the Medicare program. Medicare currently pays for only four of the 44 preventive services recommended for the elderly by the U.S. Preventive Services Task Force (pneumococcal and hepatitis B vaccinations, Pap smears, and mammography). In addition, Congress has funded demonstration programs for the influenza vaccine and comprehensive preventive services. The preventive services added to Medicare reflect the bias of the biomedical model toward screening and immunizations. Counseling services have received the least legislative attention. Factors associated with successful enactment include ...
Studies of young, employed populations have established an association between risk factors for c... more Studies of young, employed populations have established an association between risk factors for cardiovascular disease and health care costs, but an association has never been demonstrated in an elderly population. For the surviving elderly cohort (63 to 93 years of age) of the Framingham Heart Study (n = 1,053), we estimated a model regressing Medicare reimbursements per beneficiary over two years (1984 and 1985) on the two-year probability of cardiovascular disease at Exam 17 (1982 or 1983), controlling for other risk factors and prior health services use. Using the coefficient for the two-year probability for cardiovascular disease, we estimated Medicare cost ratios and dollar values associated with elevated compared with nonelevated risk for 12 risk profiles for cardiovascular disease. The average level of risk for cardiovascular disease in the elderly is associated with Medicare claims costs that are 19% higher (95% confidence interval [CI] = 10%, 29%) than those for persons wi...
One of the most important factors affecting the use of preventive services is health insurance co... more One of the most important factors affecting the use of preventive services is health insurance coverage; however, until recently, most public and private health plans have explicitly excluded coverage of most preventive care. As a result, preventive services are used less frequently than recommended guidelines suggest, which contributes to the high incidence of preventable morbidity and mortality in the United States. Recent congressional efforts to enact national health care reform legislation present an important opportunity to analyze coverage for preventive services. This article presents the results of an analysis of the prevention benefits in 23 comprehensive health care reform bills introduced in 1991 during the first session of the 102nd Congress. I classified each bill by type (employer-based, single payer, managed competition, tax credit, and insurance market reform) and through a content analysis identified benefits for immunization, screening, and counseling services (in...
1. Am J Prev Med. 1994 Sep-Oct;10(5 Suppl):1-31. Health promotion and disease prevention in healt... more 1. Am J Prev Med. 1994 Sep-Oct;10(5 Suppl):1-31. Health promotion and disease prevention in health care reform. Schauffler HH, Faer M, Faulkner L, Shore K. Department of Social and Administrative Health Sciences, School ...
In summary, the managed care system we propose for preventive services is designed to limit the p... more In summary, the managed care system we propose for preventive services is designed to limit the potential for overcare under FFS payment and for undercare under capitation and comprehensive fixed fees. It bases payment on the provision of a complete set of preventive services, thus limiting the tendency of physicians to provide only the relatively high-profit services, such as screening tests, while neglecting the lower-profit services, such as counseling. It also allows primary care providers to outsource selected services to lower-cost providers, such as laboratories, health educators, and counselors, and community-based health promotion programs, thus encouraging greater efficiency. In addition, the proposed system funds both primary and high-risk preventive case management to ensure that individuals receive preventive services appropriate to their age, sex, and risk factors. Finally, the proposed system monitors the use of preventive services, relying on physician reminders to stimulate the appropriate provision of preventive care and denying payment for unauthorized care. Existing research suggests that none of the individual strategies for managed care can be expected to achieve all of the goals of managing and promoting the appropriate use of preventive services as defined by the U.S. Preventive Services Task Force (1989). To be most effective, we conclude that the strategies need to be coordinated and integrated into the current health care delivery practices of HMOs, PPOs, and point-of-service plans. In addition, the strategies require additional provider training in preventive care. With this support, the proposed model has the potential to improve quality, control costs, and increase the appropriate use of preventive care. While many of the individual components of the proposed managed care model have been evaluated for preventive services, a great deal more research is needed to evaluate the effect of combining these elements into a coordinated and comprehensive approach to managing preventive care. Research is also needed on workable ways to invite people not currently receiving medical care into the health care system to receive preventive care. To inform policy development, the impact of the proposed managed care model--both on preventive services utilization for specific screening, immunization, and counseling services, and on total health care costs and patient health status outcomes--needs to be evaluated.
There has been increasing interest in using patient satisfaction as an indicator of quality of ca... more There has been increasing interest in using patient satisfaction as an indicator of quality of care by the purchasers of health plans, as well as the basis for marketing by competing plans. Few studies have examined if availability and utilization of health promotion programs are associated with patient satisfaction with the health plan. Data from the Bay Area Business Group on Health 1992 Employee Medical Plan Satisfaction Survey were used to examine these relationships. The findings indicate that persons enrolled in staff-model health maintenance organizations are much more likely to be offered health promotion programs by their plan or physician compared with persons enrolled in independent practice association-model health maintenance organizations and indemnity plans. However, regardless of plan type, employees who have been offered stop-smoking programs, stress management programs, weight-control programs, cholesterol screening and blood pressure screening, or any health promotion program by their plan or physician are more satisfied with their health plan than whose who have not. In addition, employees who have participated in a health promotion program also are more satisfied than employees who have not participated in such a program. The findings have important implications for designing and restructuring health plans to better meet consumer preferences.
Uploads
Papers by H. Schauffler