Progress 04/01/95 to 09/30/09
Outputs
OUTPUTS: The objectives of the project were to study the organization and financing of personal health services in the U.S. and other highly industrialized countries; role of health services in social and economic development; hospital cost containment; comparative health studies; health and social services policy and planning. Dissemination of the results of this research will be discussed in a book currently being proposed. PARTICIPANTS: Not relevant to this project. TARGET AUDIENCES: Not relevant to this project. PROJECT MODIFICATIONS: Not relevant to this project.
Impacts
A book proposal has been prepared and the unifying theme of the book asserts that the prevailing wisdom guiding health policy thinking is rooted in historical convictions and circumstances that have been superceded by changes in social and economic development. Progress in dealing with issues now at the forefront of health policy suffers from the polarizing effects of doctrinaire polemics that belie the complexities involved and obscure the long-term ramifications of popular solutions. Practicality and pragmatism are advanced as an alternative to ideological panaceas in the interest of promoting a more realistic mindset for dealing with today's health care dilemmas. The core assumptions and beliefs that have long guided health policy are badly outdated, as evidenced in the severe strains on health care financing and shortcomings in the way health services are organized and provided. Radical changes in population structure and world trade, compounded by advances in medicine and public health together with rising public expectations for more and better services, compel a re-examination and revision of the conventional wisdom hampering meaningful health care reform. In addition to reassessing how to achieve universal health coverage in the wake of alarming growth in the size of the uninsured population, policymakers need to reconsider the way private health insurance is structured and the corollary rights and responsibilities of individuals in health care financing and delivery. While necessary, universal coverage alone is insufficient. Absent complementary structural improvements, spending is destined to continuing rising at unsustainable levels. Despite long standing reform efforts, health care remains surprisingly backward. It retains many features of an earlier cottage industry stage at odds with advanced managerial and corporate practices for attaining efficiency gains, and productivity and quality controls. The unusually obstinate resistance to modernization encountered in health care is described within the context of a historically powerful medical culture that is slowly yielding to the imperatives of contemporary demands and social expectations.
Publications
- No publications reported this period
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Progress 01/01/06 to 12/31/06
Outputs
Study of 1) health leadership development and performance issues; and 2) the restructuring of employer provided health insurance coverage within the context of new demographic and economic realities compelling a reexamination of long-standing health policy assumptions and beliefs. A chapter outline of a book on health leadership; and plans is in draft form; and the preparation of a health policy text is under consideration.
Impacts
Published health leadership development article has contributed to discussion and reappraisal of curriculum content within graduate programs of health administration education. Writings on transforming health insurance from a defined benefit to a defined contribution have assisted in repositioning the concept of consumer driven health plans from a marginal to a mainstream option, the acceptance of which is rapidly growing among employers and employees.
Publications
- No publications reported this period
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Progress 01/01/05 to 12/31/05
Outputs
Continuation of study and research of financial, legal and political developments impacting the future of employment-based health insurance, in particular the mounting pressures on employers to substitute defined contribution for defined benefit plans and the potential advantages and disadvantages of such consumer driven plans as health savings accounts or high dectible plans, along with the implications for a possible revival of nonprofit staff and group model health maintenance organization. An article on the study is in draft form.
Impacts
Increase the legitimacy of solutions to the health cost containment problem that challenge the conventional wisdom and open the minds of key decision-makers to new approaches that are less radical than commonly assumed in as much as they parallel ongoing changes in public and private retirement programs. With regard to health leadership preparation, publication of scholarly insights help to raise awareness of educators to need to adapt curricula to better reflect the new realities that are reshaping the organization and financing of health services.
Publications
- Battistella, R.M. et al. 2005. Leadership Development in MHA Programs. Journal of Health Administration Education, Vol. 22, No. 3 Summer, 2005
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Progress 01/01/04 to 12/31/04
Outputs
Continuation of study and research of financial, legal and political developments impacting the future of employment-based health insurance; in particular the mounting pressures on employers to substitute defined contribution for defined benefit plans and the potential advantages and disadvantages of either vouchers or medical savings accounts, and ramifications for employers, employees and the public interest. One article has been published and another has received tentative approval for publication.
Impacts
Increase the legitimacy of solutions to the health cost containment problem that challenge the conventional wisdom and open the minds of key decision-makers to a new approach that is less radical than commonly assumed in as much as it builds on precedent and reforms in retirement programs and other fringe-benefit areas.
Publications
- Burchfield, D. and Battistella, R.M. 2003. Consumer Directed Health Care: Three Options, One Reality. Employee Benefit Plan Review, 57(June, 2003).
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Progress 01/01/03 to 12/31/03
Outputs
Continuation of study and research of financial, legal and political developments impacting the future of employment-based health insurance; in particular the mounting pressures on employers to substitute defined contribution for defined benefit plans and the likelihood of such a transformation materializing in the form of either vouchers or medical savings accounts, together with the advantages and disadvantages of each in the light of the ramifications for employers, employees and the public interest.
Impacts
Increase the legitimacy of solutions to the health cost containment problem that challenge the conventional wisdom and open the minds of key decision-makers to a new approach that is less radical than commonly assumed in as much as it builds on precedent and reforms in retirement programs and other fringe-benefit areas.
Publications
- No publications reported this period
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Progress 01/01/02 to 12/31/02
Outputs
Continuation of study and research of financial, legal and political developments impacting the future of employment-based health insurance; in particular the mounting pressures on employers to substitute defined contribution for defined benefit plans and the liklihood of such a transformation materializing in the form of either vouchers or medical savings accounts, together with the advantages and disadvantages of each in the light of the ramifications for employers, employees and the public interest.
Impacts
Inrease the legitimacy of solutions to the health cost containment problem that challenge the conventional wisdom and open the minds of key decisionmakers to a new approach that is less radical than commonly assumed in as much as it builds on precedent and reforms in retirement programs and other fringe-benefit areas.
Publications
- No publications reported this period
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Progress 01/01/01 to 12/31/01
Outputs
Continuation of study and reasearch of financial, legal and political developments impacting the future of employment-based health insurance; in particular the mounting pressures on employers to substitute defined contribution for defined benefit plans and the liklihood of such a transformation materializing in the form of either vouchers or medical savings accounts, together with the advantages and disadvantages of each in the light of the ramifications for employers, employees and the public interest.
Impacts
Inrease the legitimacy of solutions to the health cost containment problem that challenge the conventional wisdom and open the minds of key decisionmakers to a new approach that is less radical than commonly assumed in as much as it builds on precedent and reforms in retirement programs and other fringe-benefit areas.
Publications
- No publications reported this period
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Progress 01/01/00 to 12/31/00
Outputs
Continuation of analyses of new financial realities,(global competition, deregulation of sheltered industries, together with speed and accessability of price information via the internet) curtailing employer pricing power to offset rising fringe benefit costs; and legal developments exposing employers to massive punitive damages, in company with aging workforce needs for more costly health services, points to a transformation of job-based health insurance in the near future from defined benefit to defined contribution plans in which insurance ownership responsibilities are assumed by employees in the form of vouchers and/or medical savings accounts. The same applies to publicly funded programs, such as Medicare, because of macroeconomic pressures on government to reduce the burden of debt payments and raise the proportion of investment spending relative to consumption spending by controlling the growth of open-ended entitlement program spending.
Impacts
First academic researcher to challenge the prevailing wisdom and explain and publicize the rationale for defined contribution plans. Publications, media interviews and conference presentations has stimulated considerable interest and activity among benefit consulting firms, the media, and other academic researchers.
Publications
- No publications reported this period
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Progress 01/01/99 to 12/31/99
Outputs
Continuation of analyses of new financial realities,(global competition, deregulation of sheltered industries, together with speed and accessability of price information via the internet) curtailing employer pricing power to offset rising fringe benefit costs; and legal developments exposing employers to massive punitive damages, in company with aging workforce needs for more costly health services, points to a transformation of job-based health insurance in the near future from defined benefit to defined contribution plans in which insurance ownership responsibilities are assumed by employees in the form of vouchers and/or medical savings accounts. The same applies to publicly funded programs, such as Medicare, because of macroeconomic pressures on government to reduce the burden of debt payments and raise the proportion of investment spending relative to consumption spending by controlling the growth of open-ended entitlement program spending.
Impacts
First academic researcher to challenge the prevailing wisdom and explain and publicize the rationale for defined contribution plans. Publications, media interviews and conference presentations has stimulated considerable interest and activity among benefit consulting firms, the media, and other academic researchers.
Publications
- Battistella, R.M. and Burchfield, D.C. 2000. The Future of Employment-Based Health Insurance. Journal of Healthcare Management, Vol.45, No.1, pp. 46-57; Battistella, R.M. Book chapter Forthcoming. Imperatives for Consumer Friendly Defined Contribution Health Insurance Coverage: Cost Containment Impications of Vouchers and Medical Savings Accounts. **in Regina Herzlinger (ed.).Consumer-Driven Health Care. Jossey Bass Publishers.
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Progress 01/01/98 to 12/31/98
Outputs
Initiated, implemented and extended collaborative relationship for mentoring and expediting career development of new junior colleague, David C. Burchfield, PhD., Assistant Professor ofHealth Care Financial Management, which resulted in four journal publications--of which two have been published, one has been accepted for publication, and one is under review. In addition a book chapter was published during this period which was written in colaboration with a senior health services consultant.
Impacts
(N/A)
Publications
- 1. Battistella, R.M. and Burchfield, D.C. 1998. Managed Care's Future Hinges on Consumer Perceptions of its Morality. Advancing the Consumer Interest.10:5-10. 2. Battistella, R.M. and Burchfield, D.C. 1998. Defined Contribution: It's Inevitable.16:24-26. 3. Battistella, R.M. and Weil, T.P. 1988. Linking Physician and Nonphysician Management Roles in the Managed Care Era. In In Search of Physician Leadership,edited by B. LeTourneau and W. Curry, Chicago: Health Administration Press
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Progress 01/01/96 to 12/30/96
Outputs
See Publications.
Impacts
(N/A)
Publications
- "The New Management competencies: A Global Perspective." Physician Executive, 22 (July, 1996). With Thomas P. Weil
- "The Political Economy of Health Services." In Health Politics and Policy, 3rd ed. Theodore J. Litman & Leonard S. Robins eds. Albany, New York: Delmar. (Forthcoming)
- "Towards A. Blended Health Policy Strategy." With Thomas P. Weil.(Submitted for Review)
- "What Germany Can Learn from Americas Market-Driven Health Reform" with Thomas P. Weil and Gerhard Brenner. (In process)
- "Employer Disengagement From Health Insurance Provision: The Case for Vouchers."With Andrea Lewis & John Kuder. In process.
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Progress 01/01/95 to 12/30/95
Outputs
I have revised and considerably expanded a 3rd edition of the book chapter "The Political Economy of Health Services: A Review of Major Ideological Influences for the anthology of health policy readings Health Politics and Policy published by Delmar Publications in Albany, NY--the most widely used reference of its kind among graduate programs in health services management and policy. The new material, which doubles the chapter size, deals with the disengagement of government and private employers from the provisions of health and retirement benefits, and associated transitions from public entitlements to greater self responsibility and the structure of government social welfare progress. In addition, I have completed an article on management education for physicians in the managed care era which has been accepted for publication in the Physician Executive Journal. Finally, I am in the midst of completing an article on the need for programatics in achieving a balance
between the unleashing of market forces in health services reform and enlightened regulation in order to achieve the benefits of accelerated change via depolicyated of decision making without incurring unacceptably large perverse effects in which efficiency is allowed to run roughshod over equity considerations.
Impacts
(N/A)
Publications
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