Book Review: Ensuring Fairness in Health Care Coverage

The building of an employee benefit strategy requires the consideration of many perspectives: corporate direction, leadership perspective regarding the program, employee perspective, analysis of the market and plan history. But what parameters are available to guide employers in creating fair healthcare plans? While there are plenty of resources available to assist with developing perspectives on recruiting, retention and controlling costs, it is certainly more difficult to find guidance on the ethical aspects of benefit plan strategy development and administration.

Typically, the most challenging decisions employers face with regard to their benefit plan are those that impact the lives of the employees, the recipients of the benefit program. Many struggle with making fair healthcare decisions when confronted with issues such as how to help a sick dependent child who requires expensive treatments that are not covered benefits under the plan, or deciding whether to charge employees more if they smoke or are obese. When it comes to such difficult issues employers oftentimes find it difficult to reconcile issues when it comes down to weighing what is right or fair against what is cost-effective or for the good of the company.

In the book, “Ensuring Fairness in Health Care Coverage”, authors Matthew K. Wynia, MD, and Abraham P. Schwab, Ph.D., create a solid ethical framework for making even the most challenging benefits decisions. Expanded from an earlier white paper study, this book gives employers an inside look at the issues that enter into healthcare decisions along with several real-world examples and suggested solutions pulled from focus group research.

The volume focuses on what the authors outline as the “Five Ethical Guideposts for Fair Decisions.” In using these guideposts, employers should ensure their healthcare coverage decisions are:

  • Transparent (being completely open and honest about what decisions are made and why),
  • Participatory (including employees in the decision process),
  • Consistent (avoiding favoritism),
  • Sensitive to Value (providing coverage that is both efficient and effective), and
  • Compassionate (offering flexibility for special circumstances)

The authors utilize the guideposts as a means to setting perspective on healthcare decisions and analyzing them through specific case studies. Further, they assert that the guideposts are interrelated and often work in support of each other. For example, asking the employees for feedback via a survey provides a participatory avenue for employees. Straightforward and honest communication regarding the benefit program (which includes the employee’s perspective) and cost (transparency) is perceived by employees as fair, and usually appreciated. In using all five guideposts as a plan design decision framework, employers can equitably weigh the benefit outcomes and employee concerns in contrast to the cost and coverage of care.

While decisions regarding benefit plan design and administration can be some of the most complex and sensitive that human resource professionals face, this book clearly indicates that fair, creative and compassionate resolutions do not necessarily make a benefit program prohibitively expensive. When using Wynia and Schwab’s guidepost framework, employers will not only find the ability to make ethical and sensible healthcare decisions for their workers, but also place their employees in a position to understand and appreciate their healthcare benefits in the face of a changing economy.

For more information, or to purchase a copy of the book, please click here.


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By visiting the HCW Wellness Corner, employers can order various resources to help them initiate, strengthen and/or enhance their wellness initiatives. Best of all, these resources can be sent directly to the employer completely FREE OF CHARGE!

So visit the HCW Wellness Corner today at www.hcwbenefits.com, and let us help you get your company on the road to wellness!

Important Notice: Hill, Chesson & Woody does not engage in the practice of law, accounting, or medicine. Therefore, the contents of this communication should not be regarded as a substitute for legal, tax, or medical advice.

    May 8, 2009

    Hill, Chesson & Woody strives to keep our clients' group decision makers abreast of trends influencing the employee benefits market. Look for Eyes on Benefits to bring you news and information affecting you and your employees.

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