Improving Fairness in Coverage Decisions: Performance Expectations for Quality Improvement

Authors: Matthew Wynia¹; Deborah Cummins²; David Fleming³; Kari Karsjens¹; Amber Orr¹; James Sabin⁴; Inger Saphire-Bernstein⁵; Renee Witlen¹

Source: American Journal of Bioethics, Volume 4, Number 3, Summer 2004 , pp. 87-100(14)

Publisher: Routledge, part of the Taylor & Francis Group

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Abstract:

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups.

Keywords: health insurance; benefits; ethics; coverage; quality improvement; performance

Document Type: Research article

DOI: http://dx.doi.org/10.1080/15265160490497678

Affiliations: 1: American Medical Association 2: University of Illinois College of Medicine, Chicago 3: University of Missouri—Columbia School of Medicine 4: Harvard Pilgrim Health Care, Harvard Medical School 5: Blue Cross and Blue Shield Association

Publication date: 2004-06-01

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