Managed care has become the predominant form of health insurance in the United States. With its features of capitation, provider monetary risk, and population perspective, managed care represents a huge growth opportunity for advocates of disease prevention and health promotion, including those in the field of health education. In reality, however, health education’s role has fallen far short of expectations. This article is presented to initiate a dialogue on the role of health education and its subset, worksite health promotion, within managed care. The worksite is emphasized because of its attractiveness as a site in delivering population-based medicine. Furthermore, employers exercise considerable influence in shaping the health care marketplace. A list of recommendations is presented, offering suggestions on what health education needs to do to increase its impact in the managed care movement. These arguments are posed to better position this profession in a changing health care environment.
Get full access to this article
View all access options for this article.
References
1.
1. Block LE: Evolution, growth, and status of managed care in the United States. Pub Hlth Rev25:193-244, 1997.
2.
2. YaDeau RE: The evolution of managed care, in Slee VN, Slee DA, Schmidt HJ (eds.): Slee’s Health Care Terms (3rd ed.). St. Paul, MN, Tringa, 1996, pp. 353-356.
3.
3. Zwanziger J, Melnick GA: Can managed care plans control health care costs?Hlth Affairs2:186-199, 1996.
4.
4. Levit DR, Lazenby HC, Braden BR, et al: National health spending trends in 1996. Hlth Affairs17:35-51, 1998.
5.
5. Letsch S, Levite C, Waldo D: National health expenses. Hlth Care Fin Rev10:109-122, 1988.
6.
6. Simons-Morton BG, Greene WH, Gottlieb NH: Introduction to Health Education and Health Promotion. Prospects Heights, IL, Waveland, 1995.
7.
7. Fries JF, Koop CE, Sokolov J, et al: Beyond health promotion: Reducing need and demand for medical care. Hlth Care Ref17:70-84, 1998.
8.
8. Chapman LS, Nelson L, Sloan B, Plankenhorn R: Primary, secondary, and tertiary prevention capabilities of selected HMOs: Findings of an employer survey. Am J Hlth Prom12:102-109, 1997.
9.
9. Kreuter MW, Lezin NA, McPhillips-Tangum C: Commentary: Prevention capabilities among HMOs. Am J Hlth Prom12:111-111, 1997.
10.
10. Stokols D, Pelletier DR, Fielding JE: Integration of medical care and worksite health promo -tion. JAMA273:1136-1142, 1995.
11.
11. Sultz HA,Young KM: Health Care USA: Understanding Organization and Delivery. Gaithersburg, MD, Aspen, 1997.
12.
12. Chenoweth D: Worksite Health Promotion. Champaign, IL, Human Kinetics, 1998.
13.
13. Schauffer HH, Rodriquez T, Milstein A: Health education and patient satisfaction. J Fam Prac42:62-68, 1996.
14.
14. Bodenhorn K, Kemper L: Spending for Health. Sacramento, California Center for Health Improvement, 1997.
15.
15. Schauffler HH, Rodriquez T: Availability and utilization of health promotion programs and sat-isfaction with health plan. Med Care32:1182-1196, 1994.
16.
16. Bodenheimer TS, Grumbach K: Capitation or decapitation: Keeping your head in changing times. JAMA276:1025-1031, 1996.
17.
17. Pelletier KR, Marie A, Krasner M, Haskell WL: Current trends in the integration and reimburse -ment of complementary and alternative medicine by managed care, insurance carriers, and hos -pital providers. Am J Hlth Prom12:112-123, 1997.
18.
18. U.S. Department of Health and Human Service: National survey of worksite health promotion activities: Summary. Am J Hlth Prom8:452-464, 1993.
19.
19. Lippman H: Business and Health’s seventh annual executive opinion poll. Bus and Hlth14:44-57, 1996.
20.
20. Rose JR, Napach B: Do employers really care about quality?Medical Economics72:15-15, 1995.
21.
21. Pellitier K: Outcome studies of comprehensive health promotion and disease prevention pro -grams at the worksite: 1993-1995 update. Am J Hlth Prom10:380-388, 1996.
22.
22. DeJoy DM, Wilson MG: Critical Issues in Worksite Health Promotion. Boston, Allyn & Bacon, 1995.
23.
23. Anderson CA: The economics of health promotion. Nurs Outlook45:106-106, 1997.
24.
24. Rundall TG, Schauffler HH: Health promotion and disease prevention in integrated delivery systems: The role of market forces. Am J Prev Med13:244-250, 1997.
25.
25. U.S. Department of Health and Human Services: Healthy People 2000: National Health Pro -motion and Disease Prevention Objectives. Washington, DC, Government Printing Office, 1991. (DHHS Publication No. PHS 91-50213)
26.
26. Schauffler HH, Rodriquez T: Exercising purchasing power for preventive care. Hlth Affairs15:73-85, 1996.
27.
27. National Committee for Quality Assurance: Health Plan Employer Data and Information Set. Washington, DC, NCQA, 1993.
28.
28. Schauffler HH, Chapman SA: Health promotion and managed care: Surveys of California’s health plans and populations. Am J Prev Med14:161-167, 1998.
29.
29. Hollister-Morganti H: The Prevalence of Health Promotion in Health Maintenance Organiza-tions. Paper presented at the Art and Science of Health Promotion Conference of the American Journal of Health Promotion, Monterey, CA, March 1998.
30.
30. Brannon R, Orrick S: Women and managed care: The employer’s perspective. Women’s Hlth Iss8:15-31, 1998.
31.
31. Chapman L: Benchmarking best practices in workplace health promotion. The Art Hlth Prom1:1-8, 1997.
32.
32. Chapman L: The role of demand management in health promotion. The Art Hlth Prom2:1-7, 1998.
33.
33. Lippman H: Another health cost explosion: It’s not inevitable. Bus and Hlth15:27-32, 1997..
34.
34. O’Donnell MP, Bishop CA, Kaplan DL: Benchmarking best practices in workplace health pro -motion. The Art of Hlth Prom1:1-8, 1997.
35.
35. Wilson MG: A comprehensive review of the effects of worksite health promotion on health-related outcomes: An update. Am J Hlth Prom11:107-1071996.
36.
36. Eriksen MP, Gottlieb NH: A review of the health impact of smoking control at the workplace. Am J Hlth Prom13:83-104, 1998.
37.
37. Hennrikus DJ, Jeffery RW: Worksite intervention for weight control: A review of the liter ature. Am J Hlth Prom10:471-498, 1996.
38.
38. Glanz K, Sorensen G, Farmer A: The health impact of worksite nutrition and cholesterol inter-vention programs. Am J Hlth Prom10:453-470, 1996.
39.
39. Murphy L: Stress management in work settings: A critical review of the health effects. Am J Hlth Prom11:112-135, 1996.
40.
40. Eddy JM, Fitzhugh EC, Wojtowicz GG, Wang MQ: The impact of worksite-based safety belt programs: A review of the literature. Am J Hlth Prom11:281-289, 1997.
41.
41. Anderson DR, Staufacker MJ: The impact of worksite-based health risk appraisal on health-related outcomes: A review of the literature. Am J Hlth Prom10:499-508, 1996.
42.
42. Roman PM, Blum TC: Alcohol: A review of the impact of worksite interventions on health and behavioral outcomes. Am J Hlth Prom11:136-149, 1996.
43.
43. Shephard RJ: Worksite fitness and exercise programs: A review of methodology and health impact. Am J Hlth Prom10:436-452, 1996.
44.
44. Heaney CA, Goetzel RZ: A review of health-related outcomes of multi-component worksite health promotion programs. Am J Hlth Prom11:290-307, 1997.
45.
45. Skekelle PG, Schriger DL: Evaluating the use of appropriateness method in the Agency for Health Care Policy and Research clinical practice guideline development process. Hlth Ser Res31:453-468, 1996.
46.
46. Association of Worksite Health Promotion. Northbrook, IL.
47.
47. Pronk NP, Entzion K: Worksite health promotion and managed care: Creating partnerships for population health improvement. Worksite Hlth5:10-17, 1998.
48.
48. Pronk NP, O’Connor PJ: Systems approach to population health management. J Ambul Care20:24-31, 1997.
49.
49. Zimmerman EM, Horton-La Forge B: Detection and prevention of cardiac risk factors: Health risk assessment and targeted follow-up in a managed care population. J Cardiovascular Nurs11:27-38, 1996.
50.
50. Thompson RS, McAfee TA, Stuart ME, et al: A review of clinical prevention services at Group Health Cooperative of Puget Sound. Am J Prev Med11:409-416, 1995.
51.
51. MaAfee T, Sofian NS, Wilson J, Hindmarsh M: The role of tobacco intervention in popula-tion-based health care: A case study. Am J Prev Med14:46-52, 1998.
52.
52. Pelletier KR: Clinical and cost outcomes of multifactorial, cardiovascular risk management interventions in worksites: A comprehensive review and analysis. JOEM12:1154-1169, 1997.
53.
53. Schauffler HH, Brown ER, Rice T: The State of Health Insurance in California, 1996. University of California at Berkeley, Health Insurance Policy Program. Regents of the University of California, 1997.
54.
54. Hilzenrath DS: Finding something left to squeeze. The Washington Post National Weekly, July 14, 1997, p. 20-20.
55.
55. O’Donnel M, Whitmer R, Anderson D: Is it time...for a national health promotion agenda?Am J Hlth Prom13:139-142, 1999.
56.
56. Witmer RW: Worksite health promotion and health care reform: An update. Am J Hlth Prom9:5-8, 1994.
57.
57. Golaszewski T, Barr D, Blodgett C, Delprino R: Continued development of an organizational health assessment. Worksite Hlth2:32-35, 1996.
58.
58. Golaszewski T, Douma A: Implications of managed care on health educator preparation. J Hlth Educ22:53-56, 1991.
59.
59. MacStravic S, Montrose G: Managing Health Care Demand. Gaithersburg, MD, Aspen, 1998.
60.
60. Chapman L: What newer forms of health management technology can be used in program-ming?The Art of Hlth Prom1:1-7, 1997.
61.
61. Sorenson G, Himmelstein JS, Hunt MD, Youngstrom R, et al: A model worksite cancer preven-tion: Integration of health protection and health promotion in the WellWorks Project. Am J Hlth Prom10:55-62, 1996.
62.
62. Golaszewski T, Barr D, Cochran S: An organization-based intervention to improve support for employee heart health. Am J Hlth Prom13:26-35, 1998.
63.
63. D’Aunno T: Business as usual? Changes in health care’s workforce and organization of work. Hosp Hlth Ser Admin41:3-18, 1996.
64.
64. Schauffler HH: Public policy for health promotion and disease prevention. Am J Prev Med10(suppl.):4-8, 1994.
65.
65. Fries J: Reducing the need and demand for medical services. Psychosomatic Med60:140-142, 1998.
66.
66. Wassel ML: Occupational health nursing and the advent of managed care: Meeting the chal -lenges of the current health care environment. AAOHN43:23-28, 1995.
