Containing Health Benefit Costs: The Self-Insurance Option by Richard H. Egdahl M.D., PhD., Diana Chapman Walsh M.S.

By Richard H. Egdahl M.D., PhD., Diana Chapman Walsh M.S. (auth.), Richard H. Egdahl M.D., PhD., Diana Chapman Walsh M.S. (eds.)

The springboard for this 6th quantity within the and healthiness Care sequence was once a convention backed through the guts for and healthiness Care of Boston collage on June nine and 10, 1978. That convention had a gentle genesis. Over a 12 months in the past we spent a while with Kevin Stokeld of Deere and corporate and heard his perspectives on self-insurance and self-administration as one equipment for a company to accomplish larger administration regulate of its overall healthiness gain. newer discussions with representatives of yankee mobile and Telegraph corporation and different agencies made it more and more transparent to us that management's desire for facts to observe using worker overall healthiness merits used to be rising as a serious coverage factor. next conferences with executives at John Hancock Mutual existence coverage corporation in Boston and Mobil Oil company in big apple, between others, confident us that straightforward solutions will be elusive or insufficient and that there has been a necessity for an aim and cautious examine the evolving relationships among worker healthiness advantages, claims management, overall healthiness providers usage, and corpo­ fee overall healthiness care expense containment courses. on the grounds that self-funding and especially self-administration signify a enjoyable­ damental switch within the conventional coverage courting, the convention used to be convened to discover the benefits and downsides of self-insurance for worker future health advantages, with a few realization to claims construction yet with targeted emphasis at the originating query of information for powerful administration of an worker future health benefit.

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The problem is that cost containment costs money. So we, as carriers, must have a very, very open dialogue with our customers about what their needs are and what they want us to do. Because when we start pulling this material together and refusing claims or whatever-intervening in the delivery system as we're calling it here-we had better have our customer alongside or we will fail. Joseph W. Mullen, Jr. These concerns give rise to a kind of chicken-and-egg debate. Some corporate policyholders are demanding data from their carriers, feeling that without the data in hand and a better feel for both the exact nature and scope of the utilization problems they may face and the range of workable solutions within their grasp, they cannot predict what corrective measures the data might support.

Froehlke On the other hand, it can be argued that the large accounts can lead the way to improvements that will eventually save money for all: I have a different view of the subsidization of the smaller company by the larger. I think any progress that can be made by intervention in the health delivery system will have a favorable impact on health care costs overall. To the extent that large corporations lead in that struggle and achieve some results, the impact will be felt all the way down the line, even by very small employers.

I think any progress that can be made by intervention in the health delivery system will have a favorable impact on health care costs overall. To the extent that large corporations lead in that struggle and achieve some results, the impact will be felt all the way down the line, even by very small employers. John Hickey The impact will depend on the kind of intervention you are talking about. Many interventions I have heard discussed focus somewhat narrowly; an HMO that may serve only a large company, for example.

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