Does Equity Matter in Managed Care?

描述(由申请人提供)：这项建议涉及AHRQ的研究重点，即“制定战略，将个人的价值观和公平考虑纳入成本效益分析”。要了解这一优先事项，有必要了解人们在公平方面所看重的东西。因此，我们提出以下具体目标：1)确定团体模型HMO的成员对健康和医疗保健公平的理解；2)评估这些成员愿意在他们自己的健康计划中做出的效率和公平权衡；3)比较和对比美国HMO成员对公平的偏好和英国公民对其国民健康服务的偏好；4)开发将公平偏好纳入正式成本效益评估的衡量工具和分析指南。我们将在英国约克大学目前正在进行的工作的基础上再接再厉，并将邀请约克团队的两名研究人员(PI和定性方法学家)作为顾问。我们将修改一个自我管理的公平-效率权衡工具，该工具由英国团队开发并成功利用，该提议的视角和重点是美国管理式医疗，因此修改将集中于创建一个与该人群相关的工具。这项研究将涉及1)5个4-6人的焦点小组，2)10-15人对该工具的认知预测试，3)向研究HMO的成年成员样本发放2000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，因为管理保健参与者在他们的健康计划中感知到公平，无论参与者是否认为该论坛应该讨论NULTY，以及被视为最重要的特定公平问题。利用来自焦点小组的信息，我们将修改该工具，然后对修改后的工具进行认知预测试，以确定其自我管理的可用性。我们预计对调查的回复率约为50%。这项研究将从封闭式小组管理式医疗的角度首次了解公平问题，封闭式小组管理式医疗是一种覆盖很大一部分美国人口的管理式医疗组织形式。我们预计，这项工作将对政府和管理保健计划内的政策制定者以及努力将公平性纳入成本效益分析的研究人员具有重要意义。

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.