Consumer-Driven Health Care: Implications for Providers, Payers, and Policy-Makers / Edition 1

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Professor Herzlinger documents how the consumer-driven health care movement is being implemented and its impact on insurers, providers, new intermediaries, and governments. With additional contributions by health care’s leading strategists, innovators, regulators and scholars, Consumer-Driven Health Care presents a compelling vision of a health care system built to satisfy the people it serves.

This comprehensive resource includes the most important thinking on the topic and compelling case studies of consumer-driven health care (CDHC) in action, here and abroad, including new consumer-driven intermediaries for information and support; types of insurance plans; focused factories for delivering health care; personalized drugs and devices; and government roles.

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Product Details

  • ISBN-13: 9780787952587
  • Publisher: Wiley
  • Publication date: 4/28/2004
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 928
  • Sales rank: 1,419,028
  • Product dimensions: 7.24 (w) x 9.46 (h) x 2.47 (d)

Meet the Author

Regina E. Herzlinger is the Nancy R. McPherson Professor of Business Administration at the Harvard Business School.

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Read an Excerpt

Increased consumer control of health care is shaking up the medical and insurance systems. In Consumer-Driven Health Care, Harvard Business School's acclaimed professor Regina E. Herzlinger states that hospitals, doctors, benefits administrators, accountants, government policymakers, and insurers had better adapt or else they will be replaced.

Professor Herzlinger documents how the consumer-driven health care movement is being implemented and its impact on insurers, providers, new intermediaries, and governments. With additional contributions by health care's leading strategists, innovators, regulators and scholars, Consumer-Driven Health Care presents a compelling vision of a health care system built to satisfy the people it serves.

"Professor Herzlinger provides a compelling argument for consumer-driven health care. The health care system has been marked for decades with rising costs and consumer dissatisfaction. Professor Herzlinger challenges the reader to look beyond solutions that are based on what consumers should want to solutions that give consumers what they want."
—Barbara Bigelow, Ph.D., Co-Editor, Health Care Management Review, Professor of Management, Clark University Graduate School of Management

"Regina Herzlinger has a formidable reputation as an expert on reforming health care. There are lessons here for all of us who care about reforming our health systems to make them better."
—David Willets, MP, Shadow Work and Pensions Secretary and Member of Parliament , UK

"This book is a must-read for anyone who wants to know why the American model of health insurance benefits that has been around for about 50 years is all washed up, and what is most likely to replace it."
—Roger Feldman, Blue Cross Professor of Health Insurance, University of Minnesota

"Professor Herzlinger can persuade corporate CEOs, Washington policymakers, benefits administrators, and hospital executives to reshape their strategy based on a market run by consumers. This book translates health economics into simple English, reducing the "mystery-inside-a-conundrum" field into everyday transactions like selecting a health plan that any health care consumer can recognize. Consumer-Driven Health Care will be a top candidate for health care's 'book of the year.' "
—Russell C. Coile, Jr., consultant, editor, Russ Coile's Health Trends, and author, Competing On Excellence (2003)

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Table of Contents

Preface xvii
Introduction xix
Part 1 Why We Need Consumer-Driven Health Care 1
1 Fear and Loathing of Defined Benefit Health Insurance 3
2 The Frayed Safety Net 28
3 The Solution 57
4 Consumer-Driven Health Insurance: What Works 74
5 Health Care Productivity 102
6 The Silent Revolution 127
7 Scare Stories, Opponents, and the Role of Government 153
8 How to Make Consumer-Driven Health Care Happen 195
Part 2 Vision and Models 199
9 The Future of Twenty-First Century Health 203
10 How Employers Can Make Consumer-Driven Health Care a Reality 213
11 Designing Health Insurance for the Information Age 224
12 Risk Adjustment: An Overview and Three Case Studies 242
13 Consumer-Driven Health Care: Dialogues with Socrates 262
14 Employee Tax Payments and Consumer-Driven Health Care 270
15 The Implications of Tax Rulings on "Savings Accounts" 279
16 You Just Can't Pay Tom, Juan, and Ashley the Old Way Anymore 284
17 The Federal Employees Health Benefits Program 291
18 Health-Based Premium Payments and Consumer Assessment Information 298
19 The Buyers Health Care Action Group: Creating Incentives to Seek the Sick 309
20 An Insurance CEO's Perspective on Consumer-Driven Health Care 317
21 An Alternative to Managed Care: A European Perspective on Informed Choice 322
22 Medical Savings Accounts and Health Care Financing in South Africa 330
23 European Health Care: The Cost of Solidarity and the Promise of Risk-Adjusted Consumer-Driven Health Care 338
24 Consumer-Driven Health Care: An International View 362
25 Challenges of Consumer-Driven Health Care 368
26 Making the Transition to Consumer-Driven Health Care 371
27 The New Consumer-Driven Health Care System 373
28 The Patient's Right to Decide 376
29 Comments on Consumer-Driven Health Care 380
30 The Evolution of Consumer-Driven Health Care 384
31 Will Consumer-Driven Health Care Work for Employers? 391
32 The Perspective of an Advocate for the Elderly 394
Part 3 The New Intermediaries 399
33 Where Will Consumer-Driven Health Care Take the Health Care System? 403
34 The Role of Information: J. D. Power's Paradigm Lessons from the Automotive Industry 410
35 Providing Information to Consumers 419
36 Consumer-Driven Health Care and the Internet 428
37 The Present and Future Roles of Information in a Consumer-Driven Health System 440
38 Who Has Star Quality? 443
39 Grounding Consumer-Driven Health Care in Social Science Research 454
40 Providing the Most-Wanted Information When Most Needed: Best Doctors 458
41 The Half-Billion Dollar Impact of Information About Quality 467
42 Buyers Health Care Action Group: Consumer Perceptions of Quality Differences 475
43 Helping Consumers Choose Among Complex Insurance Plans 487
44 CareCounsel: Consumer-Driven Health Care Advocacy 490
45 Access Health Group: A Medical Management Perspective 501
46 Consumer's Medical Resource: Helping Consumers Evaluate Medical Treatment Options 510
47 The Cost Effectiveness of Consumer-Driven Lifestyle Changes in the Treatment of Cardiac Disease 516
48 Healthtrac: Proven Reduction of the Need and Demand for Medical Services 523
49 The Healthwise Approach: Reinventing the Patient 532
Part 4 Innovative Consumer-Driven Solutions to Chronic Problems 543
50 The Role of Providers 549
51 A Disease Management Approach to Chronic Illness 561
52 Consumer-Driven Health Care: Management Matters 570
53 Consumer-Driven Health Care for the Chronically Ill 589
54 A Cost-Effective Model for High-Quality Catastrophic Care 595
55 Collaborating with Consumers to Advance Health Knowledge and Improve Practice 602
56 Package Pricing at the Texas Heart Institute 612
57 Helping Patients Manage Their Asthma: The National Jewish Approach 619
58 A Model of Focused Health Care Delivery: Shouldice Hospital 627
59 Chronic Problems, Innovative Solutions: Paving the Way to the Focused Factory 635
60 Improving Health and Reducing the Costs of Chronic Disease 643
61 The Impact of Horizontal Integration in Hospitals: HCA Healthcare Corporation 651
62 An Innovative Approach to Population Health: Kaiser Permanente Southern California 661
63 The Right Care: Vanderbilt Medical Center 669
64 Achieving Focus in Hospital Care: The Role of Relational Coordination 683
65 Consumer-Driven Health Care Is a Message of Hope 696
66 An Academic Health Center Perspective 699
67 Consumer Choice in Consumer-Driven Health Care 703
68 Individual Genetic Profiles: The Empowerment of the Health Care Consumer 707
69 Delivering the Right Drug to the Right Patient 716
Part 5 The Role of Government 727
70 The Uninsured: Understanding and Resolving an American Dilemma 731
71 A Health Insurance Tax Credit: The Key to More Coverage and Choice for Consumers 749
72 The Politics of Consumer-Driven Health Care 764
73 Health Care: What Role for Regulation? 774
74 Adult Health Insurance 779
75 AmeriChoice Corporation: The Personal Care Model 781
76 The Uninsured and Access 789
77 Consumer-Driven Health Care for the Uninsured 794
78 A Health Care SEC: The Truth, The Whole Truth, and Nothing But the Truth 797
79 Keep 'Em Honest: The Health Care SEC 811
80 The U.S. Needs a Consumer-Driven Medical Care System 816
81 Government's New Roles in the Era of Consumer-Driven Health Care 820
The Editor 829
The Participants 831
The Contributors 833
Name Index 841
Subject Index 857
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  • Anonymous

    Posted September 18, 2005

    Thoughtful Contribution on Consumer-Directed Health Care Issue

    In Consumer-Driven Health Care, Regina E. Herzlinger, a leading health care thought leader and a professor at the Harvard Business School, provides a thought-provoking look inside a new, powerful force slowly transforming America's dysfunctional health care industry. Consumer-Driven Health Care builds on her popular 1997 book Market-Driven Health Care: Who Wins, Who Loses in the Transformation of America's Largest Service Industry. In the first part of her new 900-page book, Dr. Herzlinger makes a convincing case about how and why health care is broken and why market-based solutions - which empower consumers - are best. She restates the case she made in Market-Driven Health Care for putting consumers directly in charge of their own decisions (picking insurance plans, making medical decisions). Through transparency of information, a realignment of incentives, and new tools to support decision-making by patients, the consumer-driven model gives individuals a clear stake in their own health care. While not unique to other parts of the US economy, the approach is a radical departure for the $1.7 trillion health care market. As Dr. Herzlinger makes clear in her energetic analysis, the absence of these proven market-based tools goes a long to explain why health care became our most inefficient, outdated, and error-prone industry. The second part - about 80 percent of the book - is a collection of 73 think pieces written by 92 other experts. With short introductions by Dr. Herzlinger, these articles serve as a useful initial knowledge base for a growing field with an uncertain future. The book has its limitations. For example, Dr. Herzlinger's case for the consumer-driven model fails to address the Medicare and Medicaid systems. It also leaves a variety of practical transition and execution issues unaddressed, although these are beyond the purpose of this volume. Because articles were written several years ago as part of a conference and most of the writers lack purchaser-side experience, the book also does not deal with the growing list of market-based reforms underway by large employers and innovative health plans. In addition, since the field is still in its infancy, Dr. Herzlinger is a business researcher, and the contributors are largely wide-eyed entrepreneurs, the book will likely frustrate health policy wonks and others stuck in the technical minutia and ideological fights that characterize most health care discussions. But then, that's just as well. Too often analysts forget that health care is a business and operates as a market, albeit a flawed one insulated from tools proven to drive quality and efficiency. And we need all the wide-eyed, out-of-the-box thinking we can get. Dr. Herzlinger also has her detractors. It reminds me of the old joke that there are two kinds of people in the world: people who like Wayne Newton and people who don't. Well, it seems that health care wonkdom is divided by those who like Reggie Herzlinger's ideas and those who don't. However, given the massive problems in American health care, her plain-spoken, business-savvy contributions remain as useful as they are provocative.

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