Ensuring Fairness in Health Care Coverage: An Employer's Guide to Making Good Decisions on Tough Issues

AORN Journal,  Jan, 2008  by Kerrick Lisa

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Ensuring Fairness in Health Care Coverage: An Employer's Guide to Making Good Decisions on Tough Issues Matthew K. Wynia and Abraham P. Schwab 2006, 240 pages $29.95 hardcover

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As health care costs continue to rise, employers are struggling to provide adequate and cost-effective health care coverage plans for their employees. The purpose of this book is to provide employers and those who make health care coverage decisions with a practical, ethical framework for making those decisions. The ethical framework presented by the authors has been well researched, and it guides employers in providing a health care coverage plan that is fair as well as financially prudent and legally sound.

The authors have extensive experience in ethics as it relates to the field of health care. This book was written to translate research conducted by the Ethical Force Program into a format that would be easy to understand and use. The Ethical Force Program was created in 1997 by the Institute of Ethics at the American Medical Association. A diverse group representing different perspectives of participants in health care, from consumers to regulators, led the program. Appendix B of the book contains a condensed version of this research and demonstrates some differing perspectives that are enlightening.

The authors took the extensive research from the Ethical Force Program and condensed the results into real-world examples of problems that employers who provide health care coverage face every day. They describe five ethical guideposts that ensure health care benefits are fair. The five ethical guideposts explain that fair decision making should be

* transparent,

* participatory,

* sensitive to value,

* consistent, and

* compassionate.

The book is divided into two main parts. In part I, the authors explain why it is important to use an ethical framework to make health care coverage decisions. They provide an excellent business case for making fair health care coverage decisions for employees and explain how such decisions will benefit both the employees and the organization. They also discuss what "fair" means and explore employees' perceptions of fairness. Included is a brief discussion of our current health care system and its historical origins.

In part II, the authors dedicate a chapter to each of the five ethical guideposts. Examples and steps under each guidepost can help the reader begin making decisions. At the end of each chapter are case studies that provide readers with examples of how to apply the guideposts to real-life situations. Some of the situations presented are ethical challenges that are timely, sensitive, and complex, such as whether to charge employees who have unhealthy lifestyles more for coverage.

The authors use exhibits throughout the chapters to further explain or clarify ideas. The exhibits contain a wealth of information that is concise and easy to understand. For example, a guide to the commonly used acronyms in health care coverage plans such as HMO (ie, health maintenance organization) and PPO (ie, preferred provider organization) is provided.

This book is written in a manner that makes it easy to read and understand. It is a must read for employers in all industries who must choose health care coverage plans for their employees. This book would be beneficial to companies of all sizes. It also is an excellent resource for employees who want to understand how health care decisions are made. I appreciated the ease with which the authors applied an ethical framework to this difficult subject. Although I am a 20-year veteran of the health care industry, I did not have a complete understanding of coverage plans until I read this book. It is a wonderful, timely resource that I intend to share with my colleagues.

This book is available from AMACOM, 1601 Broadway, New York, NY 10019.

LISA KERRICK

RN, BSN, MBA

DIRECTOR, SURGICAL SERVICES

DAYTON CHILDREN'S

DAYTON, OH

COPYRIGHT 2008 Association of Operating Room Nurses, Inc.
COPYRIGHT 2008 Gale Group