Question

Many consumer and health care advocacy initiatives are converging toward a mandate to provide public access to many types of information about managed care organization (MCO) performance, costs, and quality. In fact, employers in the many parts of the country who are the major purchasers of health insurance are now requiring MCOs to make “health plan performance data” available to subscribers to facilitate their choice of plans.

• Discuss and provide the rationale for your opinion on providing data in areas such as patient outcomes, compliance with national standards for preventive and chronic care, and comparative costs to the public.
• What obligation, if any, does an employer, and/or MCO have to educate subscribers in how to interpret performance data? At whose expense should such education be provided?

What are the possible benefits or disadvantages to making such performance data available to the public

Answer 1

Advantages:

1. By making data freely available to users regarding cost and quality gives transparency to user to know about the investment they are doing or purchasing. As health insurance has become mandatory for people in order to afford health care services having an idea of costing and the quality of services will help them to do evaluation better.

2. On a user perspective it enhance trust in an organisation. In a whole it's a beneficial deal for insurance company as they are gaining a good image on user perspective.

3. Ultimately people will start investing more as they understand why health insurance is making their life easier in order to afford medical services in country like US. This will lead to great progress as a company perspective.

4. People will be aware and start taking interest in knowing more about their medical history and costing details, even they will talk about benefits of having insurance in their community which will ultimately enhance customer for health care service provider company.

5. As people are well aware that their medical history is well maintained and stored and can be helpful in future screening of even their family members for example inherited cancer from family, genetic disorders etc. can be easily tracked down. That as a whole brings security for people who are investing in health insurance organisations.

Disadvantages:

1. Certain areas of medical data should be restricted in easily accessible for users, as it can be misused if not educated how to interpret it.

2. Considering the fact that individual medical history is well maintained rather than having easily access to it. Such access can lead to conflict if user have less trust on organisation. If he or she will not know how to make use of information provided than there is threat of data lynching too, and can even question on individual privacy of their medical history which should be known only to patient and family members.

3. Knowing about the quality and performance of your health insurance organisation that maybe beneficial but a user should be educated enough to know how to interpret the data. Educating data interpretation is itself a big responsibility and any sort of biasness in teaching can lead to more confusion among users.

4. The most important thing is that user should have trust in their medical professionals and insurance providers than only transparency can be maintained on both sides.