Springer Series on Industry and Health Care – serie

With this first monograph, Springer-Verlag launches an unusual publishing venture. The purpose of the Springer Series on Industry and Health Care is to explore in depth the current and potential future role of industry­ both management and labor in all private sector enterprises-as a financer of health care benefits, as a provider of health care services, and as an extremely influential "consumer" of health care. The assumption behind the series is that private industry has the capabil­ ity, as an alternative to increased government intervention, to effect major change in the health care delivery system and is beginning to show evidence of exercising that influence. The subject matter covered by the series crosses boundaries between disciplines and specialities-occupational medicine, medical care, public health, economics, business administration, law, public policy, medical sociology-and arises in disparate arenas-labor-manage­ ment relations, corporate negotiations with insurance carriers, physician­ patient interactions, public policy, and politics. The Springer Series will draw much of its material from interdisciplinary working conferences, will analyze and synthesize the discussions, add timely background material, and be published within no more than six months of the conferences on which they build. The series will consist of four monographs a year and two volumes of background papers.

The Springer Series on Industry and Health Care is intended to character­ ize present and future ways in which industry can influence the nation's health care system in the direction of greater efficiency and effectiveness. Its potential audience includes nearly everyone interested in health care because the sys­ tem's future configuration is now being influenced by corporate health pro­ grams and the involvement of individual corporate leaders in health affairs. The first volume of the Springer Series provided a broad background on industry as a payer, provider, and consumer of health services. Unlike volumes planned for the future, it did not single out any particular aspect of corporate activity in health but rather identified and catalogued the many new involve­ ments of industry, both management and labor, in the health care scene. This, the second volume in the series, is designed to complement the first and to complete the process of laying the groundwork for the series as a whole. Volume two covers the same vista as volume one, but paints with a broader brush. It seemed to us, as editors of the series and authors of volume one, that the academic and somewhat distant overview we provided could be rounded out in a second volume by someone with a more immediate and practical perspective on industry's involvement in health care.

Close followers of the evolution of the Series on Industry and Health Care will recognize in this fourth volume some continuity and some change. The essential concept behind the series remains: here, as before, we are looking to private industry as a potential agent of change in the American health care delivery system. We have made some structural accommodations, however, to comments received from readers in industry and in health services. The original concept of a topical monograph supplemented by a separate hardbound volume of background papers has yielded to the present formula in which each volume is complete in itself. The series continues to draw much of its material from interdisciplinary working conferences convened by the Bos­ ton University Center for Industry and Health Care. Rather than publish confer­ ence proceedings, we have again undertaken to analyze the discussions and to integrate with them some timely background materials. Readers have found this format a major improvement over traditional conference reports and sum­ maries.

This fifth issue in the Industry and Health Care series takes a quick turn through unpredictable and only partially charted waters. The series as a whole has set out to explore the role of industry as a potential agent of change in the health care system, and to map the courses that may lead toward control of costs. One that looks possible is the effort now being made to infuse some competition into the health care industry through organized systems of care, known as HMOs. Health maintenance organizations, especially the fee-for-service variety known as IPAs (individual practice associations), have been a particular inter­ est of the Center for Industry and Health Care, where a national data base 'on IP A performance is being established with the aid of the Robert Wood Johnson Foundation. The Center's identity with HMOs, combined with its focus on industry and health care, has afforded us unusual access to nascent corporate thinking on the pros and cons of HMO sponsorship. We are grateful for these opportunities, and for the insights industry people have shared with us. This series draws heavily on that experience.

The springboard for this sixth volume in the Industry and Health Care series was a conference sponsored by the Center for Industry and Health Care of Boston University on June 9 and 10, 1978. That conference had a gradual genesis. Over a year ago we spent some time with Kevin Stokeld of Deere and Company and heard his views on self-insurance and self-administration as one device for a corporation to achieve better management control of its health benefit. More recent discussions with representatives of American Telephone and Telegraph Company and other corporations made it increasingly clear to us that management's need for data to monitor the use of employee health benefits was emerging as a critical policy issue. Subsequent meetings with executives at John Hancock Mutual Life Insurance Company in Boston and Mobil Oil Corporation in New York, among others, convinced us that simple answers would be elusive or inadequate and that there was a need for an objective and careful look at the evolving relationships between employee health benefits, claims administration, health services utilization, and corpo­ rate health care cost containment programs. Since self-funding and particularly self-administration represent a fun­ damental change in the traditional insurance relationship, the conference was convened to explore the advantages and disadvantages of self-insurance for employee health benefits, with some attention to claims production but with special emphasis on the originating question of data for effective management of an employee health benefit.

It is a pleasure to introduce this special volume of the Industry and Health Care Series. It is special for the best of reasons: it is primarily written by industry representatives. Using the Washing­ ton Business Group on Health 1978 Annual Meeting as its starting point, this volume captures the feelings, concerns, and experience of many who are leading industry's increasingly significant presence in health policy and economics. While many of the largest companies achieve more sophisticated levels of involvement, the fact remains that most companies of all sizes and especially the smaller businesses either will not or cannot devote the time or resources to become active participants. We hope this volume will help demonstrate the value of even one person's commit­ ment. Although our organizational focus is Washington, the WBGH rec­ ognizes that, in the long run, the quality and cost of the health care most Americans receive will be-and should be-determined at the local level. To let this happen without industry involvement would represent an abdication of both responsibility and opportunity. Fortunately, we see a growth of industry involvement, growth not just in terms of numbers but also in terms of the scope of activities. • Recognizing that the key to changing provider behavior is to change the economic incentives, emanating from the major payers, em- vi Preface ployers are subjecting their employee benefit plans to the most com­ plete scrutiny in many years.

Address to the Conference on Employee Mental Wellness by Walter B. Wriston, Chairman, Citicorp The mental well-being of employees is a subject of fundamental importance to each of us, our companies, our professions, and the nation. Both the Washington Business Group on Health and Boston University's Center for Industry and Health Care should be commended for the timely initiative this conference represents. I hope it will be­ come an ongoing effort to improve the mental health services to the nation's private sector workers and their dependents. I have had a deep interest in the delivery of health care for a long time, both from the perspective of a major employer and from my participation in the governance of New York Hospital-Cornell Medical Center. It has also been my privilege to chair the Business Round­ table's Task Force on Health and to serve on the President's Labor­ Management Committee which, among other things, has been working on heaith care problems. This experience obviously does not give me any claim to special expertise on the issue of mental health. It may prove helpful, however, as we work together formulating our thoughts about the nation's health system, the role of industry, and where the mental health issue fits into the picture.