title: An evaluation of health benefit modification in Taft-Hartley health and welfare funds: implications for encouraging tobacco-cessation coverage.
abstract: BACKGROUND
  An estimated one fifth of all U.S. adult smokers receive health benefits through insurance plans administered by Taft-Hartley 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.
  
  
  OBJECTIVE
  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 2007-2008 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 modifications-including modifications regarding tobacco-cessation benefits-were 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.
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Au-Yeung
authors.forename: Susan R
authors.initials: SR
authors.lastname: Weisman
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Hennrikus
authors.forename: Jean L
authors.initials: JL
authors.lastname: Forster
authors.forename: Rodney
authors.initials: R
authors.lastname: Skoog
authors.forename: Wade
authors.initials: W
authors.lastname: Luneburg
authors.forename: Bernie
authors.initials: B
authors.lastname: Hesse
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005376:Financial Management / Q000592:standards; D006264:Health Benefit Plans, Employee / Q000331:legislation & jurisprudence / Q000592:standards*; D006801:Humans; D007342:Insurance Benefits / Q000592:standards; D007750:Labor Unions / Q000191:economics; D008910:Minnesota; D016540:Smoking Cessation / Q000191:economics* / Q000331:legislation & jurisprudence