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Balancing Influence Between Actors in Healthcare Decision Making

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Title: Balancing Influence Between Actors in Healthcare Decision Making
Author(s): Kaplan, Robert M.; Babad, Yair M.
Subject(s): healthcare patient outcome decision making actors
Abstract: Background: Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. Discussion: A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between “actors” in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. Summary: A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision making, greater involvement of patients in shared medical decision making, greater oversight of guideline development and coverage decisions, limitations on direct to consumer advertising, and the need for an enhanced role of the government as the public advocate.
Issue Date: 2011-04-19
Publisher: BioMed Central
Citation Info: Kaplan, R. M. & Babad, Y. M. 2011. Balancing Influence Between Actors in Healthcare Decision Making. BMC Health Services Research, 11(85). DOI: 10.1186/1472-6963-11-85
Type: Article
Description: © 2011 Kaplan and Babad; license BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The original version is available through BioMed Central at DOI: 10.1186/1472-6963-11-85.
ISSN: 1472-6963
Sponsor: Prepared for the Blue Sky Project, Funded by the California Endowment. Support was also provided by NIH grants 1 P01 AG020679-01A2, UCLA Claude D. Pepper Older Americans Independence Center, NIH/NIA 5P30AG028748, and CDC Grant U48 DP000056-04.
Date Available in INDIGO: 2012-03-15

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