Does Equity Matter in Managed Care?

管理式医疗中的公平性重要吗？

• 批准号: 6579848
• 负责人: DAVID H SMITH
• 金额: $ 10万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2004-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6579848
• 关键词: behavioral /social science research tag; clinical research; cost effectiveness; decision making; geographic site; health care cost /financing; health care service evaluation; health care service organization; health economics; health insurance; health services research tag; health surveys; human rights; human subject; managed care; method development; perception; psychological values; quality of life; questionnaires; socioenvironment

DESCRIPTION (provided by applicant): This proposal relates to the AHRQ research priority on "Developing strategies to incorporate individuals' values and equity considerations into cost-effectiveness analyses". To inform this priority, it is necessary to understand what people value in terms of equity. We therefore propose the following specific aims: 1) Identify what members of a group model HMO interpret as equity in health and health care; 2) Assess the efficiency and equity trade-offs that these members are willing to make within their own health plan; 3) Compare and contrast preferences for equity expressed by US HMO members with those expressed by UK citizens regarding their National Health Service; 4) Develop measurement tools and analysis guidelines for incorporating equity preferences into formal cost-effectiveness evaluations. We will build on work currently being performed at the University of York, UK, and will involve two researchers from the York team (the PI and the qualitative methodologist) as consultants. We will modify a self-administered equity-efficiency trade-off instrument that was developed and successfully utilized by the UK team, perspective and focus for this proposal is US managed care, so modifications will center on creating an instrument with relevance to that population. The study will involve 1) 5 focus groups of 4-6 people, 2) cognitive pre-testing of the instrument with 10- 15 people, 3) 2,000 pilot questionnaires administered to a sample of adult members of the study HMO, and 4) dissemination activities. The focus groups will enable us to probe notions of equity as managed care enrollees perceive it within their health plan, whether or not participants, believe Nulty ought be addressed in that forum, and the particular equity issues that are seen to be of greatest importance. Using information from the focus groups we will modify the instrument, and then cognitively pre-test the modified instrument to ascertain its usability for self-administration. We expect a response rate to the survey of about 50%. This study will provide a first glimpse of the issue of equity from the perspective of closed panel managed care, one form of managed health care organization covering a large portion of the US population. We anticipate that this work will be of great importance to policy makers, both governmental and within managed care plans, and to researchers wrestling with the incorporation of equity into cost-effectiveness analysis.

描述（由申请人提供）：本提案涉及AHRQ的研究重点“制定战略，将个人的价值观和公平考虑纳入成本效益分析”。为了说明这一优先事项，有必要了解人们在公平方面的价值。因此，我们提出了以下具体目标：1）确定一组模型HMO的成员解释为公平的健康和医疗保健; 2）评估效率和公平的权衡，这些成员愿意在自己的健康计划; 3）比较和对比的偏好，公平表达的美国HMO成员与英国公民表示，他们的国家卫生服务; 4）制定衡量工具和分析准则，将公平偏好纳入正式的成本效益评估。我们将在英国约克大学目前正在进行的工作的基础上，并将涉及来自约克团队的两名研究人员（PI和定性方法学家）作为顾问。我们将修改英国团队开发并成功使用的自我管理的公平-效率权衡工具，该提案的视角和重点是美国管理式医疗，因此修改将集中在创建与该人群相关的工具上。该研究将涉及1）5个焦点小组，每组4-6人，2）10- 15人对该工具进行认知预测试，3）向研究HMO的成年成员样本发放2,000份试点问卷，以及4）传播活动。焦点小组将使我们能够探索公平的概念，因为管理式医疗注册者在他们的健康计划中认为它，无论参与者是否认为Numbers应该在该论坛中得到解决，以及被视为最重要的特定公平问题。使用焦点小组的信息，我们将修改仪器，然后认知预测试修改后的仪器，以确定其可用性的自我管理。我们预计调查的回应率约为50%。这项研究将提供一个第一次瞥见的公平问题的角度来看，封闭式面板管理的医疗保健，一种形式的管理医疗保健组织，覆盖了美国人口的很大一部分。我们预计，这项工作将是非常重要的政策制定者，无论是政府和管理式医疗计划，并与公平纳入成本效益分析的研究人员摔跤。