CEO health

Using comprehensive data on 28 cohorts in Sweden, we analyze CEO health and its determinants and outcomes. We find CEOs are in much better health than the population and on par with other high-skill professionals. These results apply in particular to mental health and to CEOs of larger companies. We explore three mechanisms that can account for CEOs’ robust health. First, we find health predicts appointment to a CEO position. Second, the CEO position has no discernible impact on the health of its holder. Third, poor health is associated with greater CEO turnover. Here, both contemporaneous health and health at the time of appointment matter. Poor CEO health also predicts poor firm outcomes. We find a statistically significant association between mental health and corporate performance for smaller-firm CEOs, for whom a one standard deviation deterioration in mental health translates into a performance reduction of 6% relative to the mean.     

Can good health be just a fad?

A number of studies have identified health education and promotion as important contributors to health improvement. Still, a number of factors, not the least of which is the dominance of the health care system by a disease orientation, have kept the health promotion movement from making even more significant contributions to the nation's health. The knowledge and technology to make health promotion a key part of the health care system are clearly in place. What is needed is greater involvement in the movement by physicians. Physician managers can play a leading role in bringing physicians into the mainstream of health promotion activities.     

Presenteeism and health over time among Chinese employees: The moderating role of self-efficacy

The aim of this study was two-fold: first, to examine both the immediate and the lasting effects of presenteeism on health; second, to explore the moderating effect of self-efficacy on the presenteeism-health relationship in a Chinese context. We employed a two-wave study design in which presenteeism, health (i.e. physical health, mental health and exhaustion), and self-efficacy were assessed at Time 1; health was measured again at Time 2 three months later. We surveyed a diverse sample of 345 full-time Chinese employees working in Taiwan and mainland China. Hierarchical regression analyses showed that presenteeism over the previous six months was negatively related to employees' physical health, mental health and exhaustion at Time 1. However, we found no association between presenteeism and health at Time 2, after controlling for the baseline level of health, indicating that presenteeism may not have a lasting effect. Self-efficacy was found to moderate the relationships between presenteeism and all three aspects of health at Time 2, suggesting that for some individuals presenteeism may not on balance be a bad thing. The study sheds light on the association between presenteeism and health. The findings on self-efficacy also extend the literature to incorporate individual characteristics in the presenteeism context.     

The theory of S-curve discontinuity in the medical care field

Confusion reigns supreme in the health are field today. In a previous paper, I described my thoughts about the reasons for this chaos. This article reviews the gradual escalation of health care costs and many of the unsuccessful methods to control them, reiterates the theory of S-Curve discontinuity in health care and develops a "tool" that will enable physician executives to determine whether or not a product or process in health care will succeed in the near and distant future. This new tool can be of value to all health care providers, investors, health planners, politicians involved in evolving health care legislation, and any others who have an investment in the future of health care.     

The foundation for future health care.

In the March-April issue of Physician Executive, Thomas Ainsworth, MD, provided his view of the current status of health promotion within the health care delivery system. The potential, he wrote, is far greater than the realization to date, and physicians can have a significant role in the development of health promotion programs. In this article, the theory is posited that the prime factor in the failure of health promotion to achieve a more significant position in the health care field is inertia. The forces for the status quo have simply been too great to be overcome. However, consumers, providers, and payers are almost certain to be involved in a health promotion strategy that will revolutionize the health care industry.     

The Health Impact of Mandatory Bicycle Helmet Laws

This article seeks to answer the question whether mandatory bicycle helmet laws deliver a net societal health benefit. The question is addressed using a simple model. The model recognizes a single health benefit—reduced head injuries—and a single health cost—increased morbidity due to foregone exercise from reduced cycling. Using estimates suggested in the literature on the effectiveness of helmets, the health benefits of cycling, head injury rates, and reductions in cycling leads to the following conclusions. In jurisdictions where cycling is safe, a helmet law is likely to have a large unintended negative health impact. In jurisdictions where cycling is relatively unsafe, helmets will do little to make it safer and a helmet law, under relatively extreme assumptions, may make a small positive contribution to net societal health. The model serves to focus the mandatory bicycle helmet law debate on overall health.     

An Equilibrium Model of Health Insurance Provision and Wage Determination

We investigate the effect of employer‐provided health insurance on job mobility rates and economic welfare using a search, matching, and bargaining framework. In our model, health insurance coverage decisions are made in a cooperative manner that recognizes the productivity effects of health insurance as well as its nonpecuniary value to the employee. The resulting equilibrium is one in which not all employment matches are covered by health insurance, wages at jobs providing health insurance are larger (in a stochastic sense) than those at jobs without health insurance, and workers at jobs with health insurance are less likely to leave those jobs, even after conditioning on the wage rate. We estimate the model using the 1996 panel of the Survey of Income and Program Participation, and find that the employer‐provided health insurance system does not lead to any serious inefficiencies in mobility decisions.     

A framework for supporting health capability-based planning: Identifying and structuring health capabilities

The COVID-19 pandemic has highlighted that health security systems must be redesigned, in a way that they are better prepared and ready to cope with multiple and diverse health threats, from predictable and well-known epidemics to unexpected and challenging pandemics. A powerful way of accomplishing this goal is to focus the planning on health capabilities. This focus may enhance the ability to respond to and recover from health threats and emergencies, while helping to identify the level of resources required to maintain and build up those capabilities that are critical in ensuring the preparedness of health security systems. However, current attempts for defining and organizing health capabilities have some important limitations. First, such attempts were not designed to consider diverse scenarios and multiple health threats. Second, they provide a limited representation of capabilities and lack a systemic perspective. Third, they struggle to identify capability and resource gaps. In this article, we thus propose a new framework for identifying and structuring health capabilities and support health capability planning. The suggested framework has three main potential benefits. First, the framework may help policymakers in planning under high levels of uncertainty, by considering multiple realistic and stressful scenarios. Second, it can provide risk analysts with a more comprehensive representation of health capabilities and their complex relationships. Third, it can support planners in identifying resource and capability gaps. We illustrate the use of the framework in practice considering an outbreak scenario caused by three different health threats (COVID-19, Ebola, and Influenza viruses).     

National health reform advocates retrench and prepare for Medicare

With the failure of President Truman's efforts to pass compulsory health insurance for all, national health reform (NHR) advocates began to redirect their political attention to a politically powerful group of Americans who were simultaneously vulnerable from a health care point of view--the elderly. This effort culminated in the passage of Medicare under President Johnson. This article will focus on antecedents to passage of Medicare that can be found in the Eisenhower and Kennedy administrations. It will also discuss other facets of health reform proposals from the Eisenhower administration. While most proposals never became law, the legislative intent of many of them--outlawing cancellation of policies, a minimum standard health benefit package, establishment of regional health authorities, preference for prepayment plans, and establishment of a reinsurance pool administered by the federal government--is currently under active discussion by the Clinton health reform task forces.     

The consumer choice model: a humane reconstruction of the U.S. health care system

"Consumer choice," "defined contribution health programs," "voucher systems," and "health marts" are variations on a theme: employees buying their own health care. This new approach to health care purchasing, which is designed to minimize the role of employers, is being proposed by an array of economists and by both Republican and Democratic legislators as the best way to address the nation's health care ills. Although enabling national legislation is unlikely to pass soon, the debate will nevertheless change the face of health care in America. The prospect is reminiscent of the debate over "Clinton Care" in 1993--although legislation was never passed, managed care rapidly came to dominate the U.S. health care system. As this reform takes hold, beneficiaries will make their own health plan selections but will have more responsibility and may bear more cost. Providers will have to adapt to new, customer-driven requirements for performance, accountability, and communications but will also find opportunities in a marketplace that they will have a major role in shaping. Physicians, health plans, and insurers should understand how these proposals will transform their role in health care.     

Climate Change and Human Health: Estimating Avoidable Deaths and Disease

Human population health has always been central in the justification for sustainable development but nearly invisible in the United Nations Framework Convention on Climate Change negotiations. Current scientific evidence indicates that climate change will contribute to the global burden of disease through increases in diarrhoeal disease, vector-borne disease, and malnutrition, and the health impacts of extreme weather and climate events. A few studies have estimated future potential health impacts of climate change but often generate little policy-relevant information. Robust estimates of future health impacts rely on robust projections of future disease patterns. The application of a standardized and established methodology has been developed to quantify the impact of climate change in relation to different greenhouse gas emission scenarios. All health risk assessments are necessarily biased toward conservative best-estimates of health effects that are easily measured. Global, regional, and national risk assessments can take no account of irreversibility, or plausible low-probability events with potentially very high burdens on human health. There is no "safe limit" of climate change with respect to health impacts as health systems in some regions do not adequately cope with the current climate variability. Current scientific methods cannot identify global threshold health effects in order for policymakers to regulate a "tolerable" amount of climate change. We argue for the need for more research to reduce the potential impacts of climate change on human health, including the development of improved methods for quantitative risk assessment. The large uncertainty about the future effects of climate change on human population health should be a reason to reduce greenhouse gas emissions, and not a reason for inaction.     

Work-related reproductive health: a review

This paper reviews the literature concerning the impact of work on reproductive health. In doing so, it offers a framework model for guiding future research and practice. Contemporary models of occupational health usually identify at least two pathways linking exposure to workplace hazards to their effects on health. The study of work-related reproductive health has been largely restricted to the effects of the more tangible and physical hazards of work mediated by a largely physico-chemical pathway. However, the growth of research into the psycho-physiological influence of stress on reproductive health provides a new direction for research in this domain with the exploration of a complementary pathway. The extension of this new approach into the investigation of the effects of work design and management on reproductive health represents a potentially important and further development.     

Strategically integrating hospital/home care services for improved profitability

Because hospitals and home health agencies have been predominantly separate organizations, coordination of their efforts has not been optimized. However, with the recent proliferation of hospital-based home health agencies, opportunities to integrate these health care service delivery systems have increased. Bethesda Memorial Hospital, Boynton Beach, Fla., is a 362-bed not-for-profit community hospital with a Medicare-certified home health agency organized as a department of the hospital. Until recently, the home health agency was generally perceived as a separate entity whose services were distinct from hospital services. Progress toward integration of hospital and home care services was given impetus through collaboration of the home health agency administrator and a newly appointed director of medical affairs who was given the responsibility as medical director of the home health agency. A prime responsibility of the director of medical affairs was to reduce length of stay and hospital costs through appropriate resource management.     

A health strategy for Nigeria

Improving the quality, acceptance and innovation in plans developed for sectors of an economy is a critical concern to both administrators and management scientists. This article reviews the planning system for health in Nigeria and attempts to identify problems and prospects. Priority setting has been identified as a major bottleneck to the achievement of a wider health coverage to benefit the majority of the people. Recognition is given to the fact that emphasis has been misplaced in terms of budgetary allocation to health and the intra-sector allocation between curative, preventive and promotive health subsystems. Perhaps what is needed is the development of a HEALTH STRATEGY FOR NIGERIA. Community participation in setting health priorities and health education will speed up the process of achieving Health for All (HFA) by year 2000.     

Physician leadership. The time is now

During the past 30 years, third party payers have imposed virtually every imaginable form of external cost controls on the traditional health care system. All have failed. And now those paying the bills--the large-scale health care purchasers--have finally seized control. They are fomenting fundamental structural change in the health care system. In order to continue doing business with these purchasers, health care providers are finding that they must form alliances to present a comprehensive "package" of health services for the constituents of these purchasers. In short, they must form integrated delivery systems. Current developments have created a unique opportunity for physician leaders to take a commanding role in shaping the emerging American health care system.     

PAs/NPs: forging effective partnerships in managed care systems

Three issues have dominated national health policy discussions over the past three decades--how to control health expenditures, how to improve access to care, and how to ensure delivery of high-quality health services. Cost remains the principal societal concern today. An important new dimension in this debate, however, is a critical examination of the impact of the structure of the nation's health workforce on health expenditures. Within this examination, policy makers are giving specific attention to the supply of health professionals, the role of primary care, and the identification of the most appropriate professionals to deliver primary care. In particular, a renewed interest is being shown in the potential of physician assistants (PAs) and nurse practitioners (NPs) to address all three issues. This article will examine the factors that prompted this focus on health workforce issues and the implications of the use of PAs and NPs for the structure and management of the health workforce in the future.     

The role of the coordinator of care

Regardless of the specific outcome of the current health reform debate in Washington, it is likely that major changes to the health care system are in the offering. These changes, many of which are already in place or imminent in some locations, will have a major impact on the evolving relationships between physicians and hospitals. Most expect that these changes will accelerate the development of integrated health care delivery systems that will compete in the marketplace for a mixture of public and private health insurance dollars. In this system of "managed competition," health care dollars will flow to those systems that can ensure the best clinical outcomes while using the least economic resources. In this scenario, competing collaborative health networks that can manage the continuum of care will be central to the health care delivery system. The economic and political ties between physicians and hospitals will become more closely linked as government and private payers of health care services foster the development of these integrated, value-based health care delivery systems.     

The relationship between employee motivation and psychological health at work: A chicken-and-egg situation?

Although employee motivation and psychological health at work have been found to be related, it remains unclear whether motivation precedes psychological health or vice versa, and to which extent different manifestations of mental health relate to different forms of motivation at work. Using the self-determination theory and the bidimensional theory of psychological health, this complete panel design study tested the directionality of the relationship between motivation at work and psychological health at work, with a dedicated focus on the specific predictive patterns observed between 4 types of motivation at work and positive and negative indicators of psychological health at work. Eight hundred and five Canadian workers completed questionnaires at 2 times, separated by a 6-month interval. Structural equation modelling analyses indicated that only identified regulation and psychological well-being at work have a fully reciprocal relationship. Only psychological well-being at work was positively associated with the 3 most self-determined types of motivation at work 6 months later, and only identified regulation predicted psychological health at work after 6 months. External regulation was unrelated to all indicators of psychological health at work over time. By integrating 2 theoretical frameworks, this study clarified the relationships between psychological health at work and motivation at work over time.     

Self-directed health plans: alternatives to managed care enabled by new technologies

Few people believed the Internet would have much impact on the delivery of health care services. However, combined with technological advances in how computer systems are structured and implemented and knowing what doesn't work in managed care from bitter experience, the Internet is being used to create a new paradigm of alternative health insurance products. These products hold the potential to change for the better the face of health care as we know it. Self-directed health plans will be less expensive than managed care programs and offer greater predictability in health care spending. For health care providers, SDHPs' reliance upon episode allowances will create a new market for packaged or bundled services. Providers will be paid to provide solutions, not just treatment. This could represent a new model in which physicians accept a risk-adjusted payment and provide a warranty that they will do whatever necessary until the patient has reached the reasonably expected health status. This is a radical departure from the fee-for-service or capitation system.