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Health care plan decisions regarding preventive services.
D Merenstein1, H Rabinowitz, D Z Louis
1Fairfax Family Practice, Va., USA. merenst1@juno.com
Archives of Family Medicine
|July 27, 1999
Summary
Health plans influence medical decisions, with variations in how they promote preventive services. Developing evidence-based guidelines can improve health plan recommendations for preventive care.
Area of Science:
- Health Services Research
- Preventive Medicine
- Health Policy
Background:
- Health plans increasingly influence medical decisions.
- Understanding decision-making processes in healthcare is crucial.
Purpose of the Study:
- To determine health plan protocols for recommending preventive services.
- To identify methods used for developing these protocols.
Main Methods:
- Semistructured telephone interviews with medical directors from 6 major health plan types.
- Inquiry into coverage, frequency, age groups, promotion, and development of preventive service recommendations.
Main Results:
- Preventive services recommended varied little across plans, but promotion efforts differed.
- Significant variation existed in the decision-making processes for developing recommendations.
Conclusions:
- Health plans actively promote preventive services to members.
- All plans utilize task forces for coverage decisions.
- Rationalizing recommendation development through evidence-based guidelines is recommended.