Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
Am J Prev Med. 2010 Dec;39(6 Suppl 1):S30-6. doi: 10.1016/j.amepre.2010.09.010.
An estimated one fifth of all U.S. adult smokers receive health benefits through insurance plans administered by Taft-Hartley Health and Welfare Funds. Most funds do not offer comprehensive tobacco-cessation services to fund participants despite evidence that doing so would be cost effective and save lives.
This paper examines the decision-making processes of Minnesota-based fund trustees and advisors to identify factors that influence decisions about modifications to benefits.
Formative data about the process by which funds make health benefit modifications were collected in 2007-2008 from 25 in-depth key informant interviews with fund trustees and a cross-section of fund advisors, including administrators, attorneys, and healthcare business consultants. Analyses were performed using a general inductive approach to identify conceptual themes, employing qualitative data analysis software.
The most commonly cited factors influencing trustees' decisions about health plan benefit modifications-including modifications regarding tobacco-cessation benefits-were benefit costs, participants' demand for services, and safeguarding participants' health. Barriers included information gaps, concerns about participants' response, and difficulty projecting benefit utilization and success. Advisors wielded considerable influence in decision-making processes.
Trustees relied on a small pool of business, legal, and administrative advisors to provide guidance and recommendations about possible health plan benefit modifications. Providing advisors with evidence-based information and resources about benefit design, cost/return-on-investment (ROI), effectiveness, and promotion may be an effective means to influence funds to provide comprehensive tobacco-cessation benefits.
据估计，美国所有成年吸烟者中有五分之一通过塔夫脱-哈特利健康和福利基金管理的保险计划获得健康福利。尽管有证据表明，这样做将具有成本效益并拯救生命，但大多数基金并未向参与计划的人提供全面的戒烟服务。
本文考察了明尼苏达州基金受托人和顾问的决策过程，以确定影响福利修改决策的因素。
2007-2008 年，通过对 25 名基金受托人和基金顾问的深度关键知情人访谈（包括管理员、律师和医疗保健业务顾问），收集了有关基金进行健康福利修改过程的形成性数据。使用一般归纳方法对数据进行分析，以确定概念主题，并使用定性数据分析软件。
影响受托人关于健康计划福利修改（包括戒烟福利修改）决策的最常见因素是福利成本、参与者对服务的需求以及保障参与者的健康。障碍包括信息差距、对参与者反应的担忧以及预测福利利用率和成功的困难。顾问在决策过程中发挥了相当大的影响力。
受托人依赖于一小部分商业、法律和行政顾问，以提供有关可能的健康计划福利修改的指导和建议。向顾问提供有关福利设计、成本/投资回报率 (ROI)、有效性和推广的循证信息和资源，可能是影响基金提供全面戒烟服务的有效手段。
