Defining total corporate health and safety costs--significance and impact. Review and recommendations.

This is the first in a series of studies designed to assist directors of occupational health and safety services in defining, measuring, predicting, and integrating total health and safety costs into useful management information. This study was structured to review recent literature on health and safety costs and to categorize costs as either direct or indirect. This delineation should aid in defining total health and safety costs, delineating priority areas for interventions to reduce costs, and evaluating the effectiveness of health and safety programs. The significance of such efforts is underscored by the reported direct health care costs for the nation's work force of over $418 billion, and indirect costs, using the lower range of estimates for such costs, of over $837 billion. Reducing the total costs of over $1.256 trillion would have major impacts on corporate productivity and competitiveness, as well as on availability of health care programs for employees. Recommendations for follow-up activities to define costs and evaluate intervention programs are provided.

Prevention and managed care: the next generation.

As we stand at the doorway to the twenty-first century, we are witnessing the restructuring of American health care from a fragmented cottage industry to an actual health care system. This new system is emerging from a foundation of managed care and will be built upon the pillars of prevention. One of the reasons this phenomenon is occurring so rapidly is that capitated managed care shifts to providers the financial risk for the health care needs of an enrolled population. Once providers accept financial risk, it is imperative to assess and manage the medical, health, and economic risks of the enrolled population. Under these incentives, quality-driven, cost-effective care takes on new meaning to physicians. In fact, this new managed care environment begins to merge personal health and public health in such a way that the delivery system will begin to provide personal-based health care from a population-based perspective. Furthermore, the incentives and rewards for maintaining the health of a population will finally be present.

Corporate health initiatives. Restructuring the American health care system.

As we stand on the threshold of the 21st century, writes Ron Loeppke, M.D., M.P.H., corporate health is emerging as a cornerstone in the restructuring of the American health care system. Whereas traditional managed care models have been reactive, corporate health management is proactive, building on the best elements of managed care with increased emphasis on prevention and risk management.