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Applying value-based insurance design to high-cost health services
1School of Public Health, University of California, Berkeley, CA, USA. james.robinson@berkeley.edu
Health Affairs (Project Hope)
|November 3, 2010
Summary
Value-based insurance design can improve healthcare by extending cost-sharing reductions beyond preventive services. Applying these principles to high-cost specialty drugs and procedures can enhance clinical and economic value.
Area of Science:
- Health economics
- Health services research
- Insurance design
Background:
- Value-based insurance design (VBID) programs currently focus on reducing patient cost-sharing for preventive services and chronic disease medications.
- The clinical and economic impact of VBID could be significantly amplified by broadening its application.
Purpose of the Study:
- To propose extending value-based insurance design principles to a wider range of healthcare services.
- To explore the application of VBID to high-cost, evidence-limited, or controversial healthcare interventions.
Main Methods:
- Conceptual paper proposing an extension of VBID principles.
- Identifies specific service categories for potential VBID application: specialty drugs, implantable devices, advanced imaging, and major surgical procedures.
Main Results:
- Current VBID applications are limited in scope.
- Extending VBID to high-cost services and those with limited evidence is proposed as a strategy for greater impact.
Conclusions:
- Value-based insurance design principles should be expanded to include expensive services and those with uncertain evidence.
- Applying VBID to specialty drugs, medical devices, advanced imaging, and major surgeries can enhance healthcare value.
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