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Evidence-based coverage policy.

A M Garber1

  • 1Center for Health Policy, Stanford University in Palo Alto, California, USA.

Health Affairs (Project Hope)
|September 18, 2001
PubMed
Summary
This summary is machine-generated.

Health plans use evidence-based approaches for coverage decisions, focusing on systematic reviews of medical intervention effectiveness. This guides resource allocation towards effective healthcare interventions.

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Area of Science:

  • Health Policy
  • Medical Technology Assessment

Background:

  • Health plans increasingly adopt evidence-based methods for coverage decisions.
  • Systematic reviews of medical intervention effectiveness form the core of these approaches.

Purpose of the Study:

  • To discuss the principles of evidence-based coverage policy.
  • To examine the application of these principles in major health programs.

Main Methods:

  • Analysis of principles underlying evidence-based coverage policy.
  • Case study of the Blue Cross Blue Shield Association's Technology Evaluation Center.
  • Case study of the Medicare Coverage Advisory Committee.

Main Results:

  • Evidence-based coverage policies are founded on systematic reviews of medical intervention effectiveness.

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  • Two major programs, BCBS's TEC and Medicare's CAC, apply these principles.
  • These policies may have limited impact on overall healthcare spending.

    • Conclusions:

    • Evidence-based coverage policies can effectively direct medical resources toward proven interventions.
    • The systematic evaluation of medical evidence is crucial for informed coverage decisions.