Improving fairness in coverage decisions: Performance expectations for quality improvement

American Journal of Bioethics

Volumn 4, Issue 3, 2004, Pages 87-100

  Wynia, Matthew K ^a   Cummins, Deborah ^b   Fleming, David ^c   Karsjens, Kari ^a   Orr, Amber ^a   Sabin, James ^d   Saphire Bernstein, Inger ^e   Witlen, Renee ^a  

^a AMERICAN MEDICAL ASSOCIATION   (United States)

^b UNIVERSITY OF ILLINOIS   (United States)

^c University of Missouri   (United States)

^d HARVARD MEDICAL SCHOOL   (United States)

^e Blue Cross and Blue Shield Association   (United States)

Author keywords

Benefits; Coverage; Ethics; Health insurance; Performance; Quality improvement

Indexed keywords

ADVISORY COMMITTEE; ANALYTICAL APPROACH; BIOETHICS; COST BENEFIT ANALYSIS; ECONOMICS; EMPATHY; ETHICS; HEALTH CARE AND PUBLIC HEALTH; HEALTH CARE QUALITY; HEALTH INSURANCE; HEALTH SERVICES RESEARCH; HUMAN; INSURANCE; METHODOLOGY; REVIEW; SOCIAL JUSTICE; TOTAL QUALITY MANAGEMENT; UNITED STATES;

ANALYTICAL APPROACH; HEALTH CARE AND PUBLIC HEALTH;

ADVISORY COMMITTEES; BIOETHICS; COST-BENEFIT ANALYSIS; EMPATHY; HEALTH SERVICES RESEARCH; HUMANS; INSURANCE BENEFITS; INSURANCE COVERAGE; INSURANCE, HEALTH; QUALITY ASSURANCE, HEALTH CARE; RESEARCH DESIGN; SOCIAL JUSTICE; TOTAL QUALITY MANAGEMENT; UNITED STATES;

EID: 27844564233     PISSN: 15265161     EISSN: 15360075     Source Type: Journal    
DOI: 10.1080/15265160490497678     Document Type: Review

References (46)

1. Alexander, G. C., R. M. Werner, A. Fagerlin, and P. A. Ubel. 2003. Support for physician deception of insurance companies among a sample of Philadelphia residents. Annals of Internal Medicine 138:472-475.
2. Chevron v. Natural Resources Defense Council, 467 U.S. 837 (1984).
3. Crawshaw, R., D. E. Rogers, E. D. Pellegrino, et al. 1995. The patient-physician covenant. Journal of the American Medical Association 273:1553.
4. Daniels, N. 1984. Just health care. New York: Cambridge University Press.
5. Daniels, N., and J. Sabin. 1998a. The ethics of accountability in managed care reform. Health Affairs 17:50-64.
6. Daniels, N., and J. E. Sabin. 1998b. Last chance therapies and managed care: Pluralism, fair procedures and legitimacy. Hastings Center Report 28:27-42.
7. Daniels, N., and J. E. Sabin. 2002. Setting limits fairly: Can we learn to share medical resources? New York: Oxford University Press.
8. Eddy, D. M. 1991a. Oregon's methods: Did cost-effectiveness fail? Journal of the American Medical Association 266:2135-2141.
9. Eddy, D. 1991b. What care is "essential"? What services are "basic"? Journal of the American Medical Association 265:782-788.
10. Eisenberg, J. M. 2001. Can you keep a secret? Measuring the performance of those entrusted with personal health information. Journal of General Internal Medicine 16:132-134.
11. Emanuel, E. J. 2000. Justice and managed care: Four principles for the just allocation of health care resources. Hastings Center Report 30:8-16.
12. Emanuel, E. J., and L. L. Emanuel. 1996. What is accountability in health care? Annals of Internal Medicine 124:229-239.
13. Freeman, V. G., S. S. Rathore, K. P. Weinfurt, K. A. Schulman, and D. P. Sulmasy. 1999. Lying for patients: Physician deception of third party payers. Archives of Internal Medicine 159:2263-2270.
14. Gold, M. R., J. E. Seigel, L. B. Russell, and M. C. Weinstein. 1996. Cost-effectiveness in health and medicine. New York: Oxford University Press.
15. Hadorn, D. C. 1991. Setting health care priorities in Oregon: Cost-effectiveness analysis meets the rule of rescue. Journal of the American Medical Association 265:2218-2225.
16. Hirschman, A.O. 1970. Exit, voice and loyalty: Responses to decline in firms, organizations, and states. Cambridge, MA: Harvard University Press.
17. Hoffman, M. K., M. K. Wynia, and G. Balch. 2001. Focus groups with employers and insurance brokers to discuss issues that shape decisions about health benefits. Chicago: Institute for Ethics at the American Medical Association.
18. Jennings, B. 1991. Possibilities of consensus: Toward democratic moral discourse. 1991. Journal of Medical Philosophy 16:447-463.
19. Joint Commission on Accreditation of Healthcare Organisations (JCAHO). 1998. Ethical issues and patient rights: Across the continuum of care. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations.
20. Jonsen, A. 1986. Bentham in a box: Technology assessment and health care allocation. Law, medicine and health care 14:172-174.
21. Kao, A. C., D. C. Green, A. M. Zaslavsky, J. P. Koplan, and P. D. Cleary. 1998. The relationship between method of physician payment and patient trust. Journal of the American Medical Association 280:1708-1714.
22. Kassirer, J. P., and M. Angell. 1994. The Journal's policy on cost-effectiveness analysis. New England Journal of Medicine 331:669-670.
23. Kizer, K. W. 2001. Establishing health care performance standards in an era of consumerism. Journal of the American Medical Association 286:1213-1217.
24. Light, D. W., R. Castellblanch, P. Arredondo, and D. Socolar. 2003. No exit and the organization of voice in biotechnology and pharmaceuticals. Journal of Health Politics, Policy and Law 28:473-507.
25. Litwin, M. S. 1995. How to measure survey reliability and validity. Thousand Oaks, CA: Sage Publications.
26. Mechanic, D. 1998. The functions and limits of trust in the provision of medical care. Journal of Health Politics, Policy and Law 23:661-686.
27. Morreim, E. H. 1994. Of rescue and responsibility: Learning to live with limits. Journal of Medicine and Philosophy 19:455-470.
28. Nelson, R. M., and T. Drought. 1992. Justice and the moral acceptability of rationing medical care: The Oregon experiment. Journal of Medicine and Philosophy 17:97-117.
29. Nord, E. 1993. Unjustified use of the quality of well-being scale in priority setting in Oregon. Health Policy 24:45-53.
30. Nord, E. 1999. Cost-value analysis in health care: Making sense out of QALYs. Cambridge, UK: Cambridge University Press.
31. Ozar, D., J. Berg, P. H. Werhane, and L. L. Emanuel. 2000. Organizational ethics in health care: Toward a model for ethical decision making by provider organizations. Chicago: Institute for Ethics at the American Medical Association.
32. President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. 1998. Quality first: Better health care for all Americans. Available from: http://www.hcqualitycommission.gov/final/chap08.html.
33. Reinhart, U. E. 2004. An information infrastructure for the pharmaceutical market. Health Affairs 23:107-112.
34. Robinson, J. C. 2001. The end of managed care. Journal of the American Medical Association 285:2622-2628.
35. Rodwin, M. A. 1997. The neglected remedy: Strengthening consumer voice in managed care. The American Prospect 8. Available from: http://www.prospect.org/ print/V8/34/rodwin-m.html.
36. Russell, L. B., D. G. Fryback, and F. A. Sonnenberg. 1999. Is the societal perspective in cost-effectiveness analysis useful for decision makers? Joint Commission Journal on Quality Improvement 25:447-454.
37. Safran, D. G., D. A. Taira, W. H. Rogers, et al. 1998. Linking primary care performance to outcomes of care. Journal of Family Practice 47:213-220.
38. Singer, P. A. 1997. Resource allocation: Beyond evidence-based medicine and cost-effectiveness analysis. American College of Physicians Journal Club 127:A16-A18.
39. Steiner, C. A., N. R. Powe, G. F. Anderson, and A. Das. 1997. Technology coverage decisions by health care plans and considerations by medical directors. Medical Care 35:472-489.
40. Thom, D., D. Bloch, and E. Segal. 1999. An intervention to increase patients' trust in their physicians. Academic Medicine 74:195-198.
41. Wolf, S. M. 1994. Quality assessment of ethics in health care: The accountability revolution. American Journal of Law and Medicine 20:105-128.
42. Wynia, M. K. 1999. Performance measures for ethics quality. Effective Clinical Practice 2:294-298.
43. Wynia, M. K., D. S. Cummins, J. B. VanGeest, and I. B. Wilson. 2000. Physician manipulation of reimbursement rules for patients: Between a rock and a hard place. Journal of the American Medical Association 283:1858-1865.
44. Wynia, M. K., S. S. Coughlin, S. Alpert, D. S. Cummins, and Emanuel, L. L. 2001. Shared expectations for protection of identifiable health care information: Report of a national consensus process. Journal of General Internal Medicine 16:100-111.
45. Wynia, M. K., D. Cummins, K. Karsjens, and A. Orr. 2004. Appendix C: Ethics and Access to Care. In, The Ethical Force Program, Ensuring fairness in health care coverage decisions: A consensus report on the ethical design and administration of health care benefits packages, 36-38. Chicago: Ethical Force Program, American Medical Association.
46. Wynia, M. K., S. R. Latham, A. C. Kao, J. W. Berg, and L. L. Emanuel. 1999. Medical professionalism in society. New England Journal of Medicine 341:1612-1616.