Health care consumerism movement takes a step forward.

One of the contributing factors to both the increase in health care costs and the backlash to managed care was the lack of consumer awareness of the cost of health care service, the effect of health care costs on profits and wages, and the need to engage consumers more actively as consumers in health care decisions. This article reviews the birth of the health care consumerism movement and identifies gaps in health care consumerism today. The authors reveal some of the keys to building a sustainable health care consumerism framework, which involves enlisting consumers as well as other stakeholders.

Achieving a high-performance health care system with universal access: what the United States can learn from other countries.

This position paper concerns improving health care in the United States. Unlike previous highly focused policy papers by the American College of Physicians, this article takes a comprehensive approach to improving access, quality, and efficiency of care. The first part describes health care in the United States. The second compares it with health care in other countries. The concluding section proposes lessons that the United States can learn from these countries and recommendations for achieving a high-performance health care system in the United States. The articles are based on a position paper developed by the American College of Physicians' Health and Public Policy Committee. This policy paper (not included in this article) also provides a detailed analysis of health care systems in 12 other industrialized countries. Although we can learn much from other health systems, the College recognizes that our political and social culture, demographics, and form of government will shape any solution for the United States. This caution notwithstanding, we have identified several approaches that have worked well for countries like ours and could probably be adapted to the unique circumstances in the United States.

Preventing 3 million premature deaths and helping 5 million smokers quit: a national action plan for tobacco cessation.

In August 2002, the Subcommittee on Cessation of the Interagency Committee on Smoking and Health (ICSH) was charged with developing recommendations to substantially increase rates of tobacco cessation in the United States. The subcommittee's report, A National Action Plan for Tobacco Cessation, outlines 10 recommendations for reducing premature morbidity and mortality by helping millions of Americans stop using tobacco. The plan includes both evidence-based, population-wide strategies designed to promote cessation (e.g., a national quitline network) and a Smokers' Health Fund to finance the programs (through a 2 US dollar per pack excise tax increase). The subcommittee report was presented to the ICSH (February 11, 2003), which unanimously endorsed sending it to Secretary Thompson for his consideration. In this article, we summarize the national action plan.

Disease management practices of health plans.

OBJECTIVE: To investigate how health plans manage chronic diseases. STUDY DESIGN: Health plan medical directors were surveyed regarding the disease management (DM) practices of their plans. METHODS: We took a stratified random sample of 65 plans, all members of the American Association of Health Plans. Forty-five plans responded. Results were weighted to be representative of the industry (including nonmember plans). Medical directors were asked to consider that they had a DM program only if 2 things were true: (1) A majority of a plan's enrollees could not be ineligible for a DM program for non-clinical reasons (eg, geographic location); and (2) a DM program had to have at least 6 of the 8 components of a DM program as defined by the Disease Management Association of America. RESULTS: The 3 diseases most likely to be the focus of DM programs were diabetes, asthma, and congestive heart failure. For each of these diseases, at least one quarter of Americans were enrolled in plans offering a DM program. Medical directors perceived their DM programs to be highly effective in reducing mortality and morbidity and in improving the functional status of patients, and perceived them to be effective in lowering cost. The greatest challenge in implementing DM programs involves information technology. These results yield insights into the future of treatment of chronic disease in the United States. CONCLUSION: Health plans have made a significant investment in programs to improve care for chronic illness. The almost universality of DM programs highlight the need for scholarly evaluations of their effectiveness and cost effectiveness.