Harvard Pilgrim Health Care

Can the ethical mission of health care survive among organizations competing for survival in the marketplace? On this question hinges not only the future of health care in the US, but that of the health care systems of all advanced countries. This book presents both an analytic framework and a menu of pragmatic answers. The team of authors, physician-ethicists from Harvard Medical School and the National Institutes of Health, worked with a consortium of health care organizations to explore some of the most challenging dilemmas in health care today: How can health plans determine medical necessity in a way that ensures quality care, controls costs, and builds trust with patients and physicians? What are the strategies for caring for vulnerable populations that meet their special neds without dramatically increasing costs? To answer these and other similar questions the authors blend ethical analysis with real-world example. The outcome is a rich analysis of the ethical challenges facing health care organizations, combined with tangible examples of exemplary methods to address these challenges. This book will help health care leaders, regulators, and policy makers incorporate exemplary practices, and the underlying themes they embody, into the very heart and soul of health care organizations.

This book presents a cross-cutting assessment of disability income policy in public and private programs in the United States and in European countries. It evaluates whether there is a crisis in disability benefit policy, drawing on an in-depth review of Social Security disability programs by a panel of national experts. In addition to highlighting the panel's findings and recommendations for reform, the authors debate issues in financing and delivering quality health care through Medicare and Medicaid for working-age persons with disabilities, and they examine new developments in how Workers' Compensation organizes and finances cash benefits and health care for workers injured on the job. These developments in benefits and health policy for disabled workers are examined in light of budget constraints and challenges posed by today's rapidly changing labor market. The book concludes with a provocative discussion of "where are the jobs?"--an assessment of growing wage inequality between less skilled and highly skilled workers and the implication of labor market trends for goals of promoting employment among persons with chronic health conditions or disabilities. The contributors include Monroe Berkowitz, Rutgers University; Richard V. Burkhauser, Syracuse University; John Burton, Rutgers University; Philip de Jong, Institute for Law and Public Policy, Leiden University, the Netherlands; Alan Krueger, Princeton University; Katherine Newman, Harvard University; Van Ooms, Committee on Economic Development; Dallas Salisbury, Employee Benefit Research Institute; Leslie Scallet, Mental Health Policy Resource Center; and the Honorable Bruce C. Vladek, Health Care Financing Administration.