Safe Work in the 21st Century Education and Training Needs for the Next Decade's Occupational Safety and Health Personnel (2000) / Chapter Skim
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6 The Changing Delivery of Health Care
6 The Changing Delivery of Health Care
Pages 141-151
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From page 141... ...
health care system, which has been undergoing dramatic changes during the past decade. One of the most striking features of health care reform has been the dramatic growth of managed care, a major element of which is tighter control on the utilization of health care services.
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From page 142... ...
One of the continuing issues between injured workers and employers has been the control of who selects the health care providers. Changes in the ways in which health care is delivered thus have the potential to affect not only workers' access to care but also the cost and quality of that care.
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From page 143... ...
Two-thirds of Americans receive their health insurance through an employer (Fronstin, 1998~. The rising cost of health care has forced many employers to either drop health insurance coverage for their employees or eliminate some of the benefits that they provide.
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From page 144... ...
ELEMENTS OF HEALTH CARE REFORM One of the most striking features of health care reform has been the dramatic growth of managed care. There are several types of managed care organizations, including health maintenance organizations (HMOs)
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From page 145... ...
attributes the growth of managed care organizations to two factors: rising health care costs and overcapacity in the health care delivery system. It has been estimated that 75 percent of Americans with private health insurance are enrolled in managed care plans (Iglehart, 1999a)
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From page 146... ...
. Specialists and Primary Care Providers Reform of the health care delivery system has also affected the pro
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From page 147... ...
In some cases, managed care has used generalist physicians as "gatekeepers," without whose approval a patient cannot see a specialist. The number of other health care professionals such as nurse practitioners and physician's assistants has increased rapidly, and their scope of practice has been expanded to include responsibilities that were previously the exclusive domain of the physician (Cooper et al., 1998a,b)
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From page 148... ...
From the little research available, it appears that fee schedules have not reliably reduced medical costs, as providers in the predominantly fee-for-service systems delivered more or more complex services per case, offsetting the lower fees for each service imposed by the schedule (Nikolai and Boon, 1998~. Subsequent approaches to managing health care in workers' compensation cases have turned to networks of preferred providers, treatment guidelines, aggressive case management, and 24-hour coverage (Dembe, et al., 1998; Leone and O'Hara, 1998; Nikolai and Boon, 1998; Weinper,
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From page 149... ...
Several studies made systematic attempts to assess cost savings subsequent to changes in the manner in which health care was provided. In all cases, however, numerous changes were introduced simultaneously, which makes it impossible to judge their relative contributions to subsequent cost savings and other effects.
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From page 150... ...
Managed care is thus very likely to be a major part of workers' compensation for the foreseeable future. IMPLICATIONS FOR EDUCATION AND TRAINING OF OCCUPATIONAL SAFETY AND HEALTH PROFESSIONALS It is difficult to say with confidence that the market-driven changes in health care delivery will continue to evolve with cost reduction as its major theme.
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From page 151... ...
It may compete with the preventive aspects of occupational health as well. Third, emphasis on primary care physicians, nurse practitioners, physician's assistants, and other health care professionals instead of specialist physicians may undermine attempts to increase the small numbers of board-certified occupational medicine specialists.
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