|
A Model for Saving Public School Health Care Dollars
Through Large Claim Polling, Increased Competition and Improving Health Care Quality Executive Summary Health care spending, by several measures, continues to rise at the fastest rate in US history. In 2004, employer health insurance premiums increased by 11.2 percent - nearly four times the rate of inflation. While the United States spends more on health care than other industrialized countries, the US does not rank among the highest in terms of health outcomes, coverage, or "quality". "Healthy" life expectancy in the US is nearly the lowest among industrialized countries. The United States currently has over 45 million uninsured citizens and the number continues to climb. The Institute of Medicine reported that nearly 100,000 deaths per year result from avoidable medical errors. A recent study in the New England Journal of Medicine by RAND found that patients receive the recommended, evidence-based health care for their preventive, acute or chronic condition only 54.9% of the time. Without a national healthcare system, employers increasingly are shifting costs to their employees by increasing health care premium sharing, deductibles, and copays. Cost shifting strategies ignore other beneficial approaches to control health care costs and improve quality, such as collective group purchasing, efficient plan administration, and improving member health. The HayGroup report explored the feasibility and cost-effectiveness of a consolidated health care plan for K-14 public education employees. The report's suggested strategies greatly restrict the collective bargaining of health care benefits at the school district level. Further, the HayGroup approach also eliminates the benefits of heath care plan competition on cost and quality. It is our belief, however, that the savings identified in the report can be achieved and exceeded without jeopardizing the integrity of the collective bargaining process or the efficiencies found in a competitive market environment. Rather than just criticizing the HayGroup's results and proposed approach, we suggest using the findings to develop an alternative model for school employee health care insurance. The proposed model maintains employees' current bargaining rights for health care coverage, the freedom to choose their health plan, and proactive approaches to improve their health and the health of their family members. The estimated first year savings for the proposed model are $156 million, more than reported in two of the HayGroup options. Additional savings can be realized through the use of chronic care management programs, and PPOs. The following elements form the foundation of the proposed model for public school employee heath insurance:
|
