Background An estimated one fifth of all U.S. adult smokers receive health benefits through insurance plans administered by TaftHartley Health and Welfare Funds. Most funds do not offer comprehensive tobacco-cessation services to fund participants despite evidence that doing so would be cost effective and save lives. Purpose This paper examines the decision-making processes of Minnesota-based fund trustees and advisors to identify factors that influence decisions about modifications to benefits. Methods Formative data about the process by which funds make health benefit modifications were collected in 20072008 from 25 in-depth key informant interviews with fund trustees and a cross-section of fund advisors, including administrators, attorneys, and healthcare business consultants. Analyses were performed using a general inductive approach to identify conceptual themes, employing qualitative data analysis software. Results The most commonly cited factors influencing trustees' decisions about health plan benefit modificationsincluding modifications regarding tobacco-cessation benefitswere benefit costs, participants' demand for services, and safeguarding participants' health. Barriers included information gaps, concerns about participants' response, and difficulty projecting benefit utilization and success. Advisors wielded considerable influence in decision-making processes. Conclusions Trustees relied on a small pool of business, legal, and administrative advisors to provide guidance and recommendations about possible health plan benefit modifications. Providing advisors with evidence-based information and resources about benefit design, cost/return-on-investment (ROI), effectiveness, and promotion may be an effective means to influence funds to provide comprehensive tobacco-cessation benefits.
Bibliographical noteFunding Information:
This paper was supported by ClearWay Minnesota SM as part of a supplement entitled ClearWay Minnesota SM : Advancing Tobacco Control Through Applied Research (Am J Prev Med 2010;39[6S1]).
Research for and preparation of this manuscript were supported by a grant from ClearWay Minnesota SM , RC-2009-0043 . However, the contents of this manuscript are solely the responsibility of the authors and do not necessarily reflect the official views of ClearWay Minnesota.