Policy Framework for Covering Preventive Services Without Cost Sharing: Saving Lives and Saving Money?

Area of Science:

• Health Policy
• Preventive Medicine
• Health Economics

Background:

• The US Affordable Care Act (ACA) requires private insurers to cover preventive services without cost-sharing.
• A list of covered preventive services is determined by four expert committees evaluating health effects.

Purpose of the Study:

• To analyze the recommendation development process of the expert committees that select preventive services under the ACA.
• To identify inconsistencies in criteria and the lack of economic considerations in the current review process.
• To propose a framework for a more evidence-based, consistent, and ethically sound approach to selecting preventive services.

Main Methods:

• Analysis of the processes used by the four expert committees involved in recommending preventive services.
• Evaluation of the criteria utilized by each committee for assessing preventive services.
• Assessment of the extent to which economic factors are integrated into the committees' decision-making.

Main Results:

• Significant variation exists in the criteria used by different expert committees to evaluate preventive services.
• None of the committees systematically incorporate cost-effectiveness or economic considerations into their recommendations.
• The current process may lead to inconsistencies in the selection of preventive services covered under the ACA.

Conclusions:

• The existing expert committees should adopt standardized evidence review methodologies.
• The scope of preventive services reviewed should be expanded.
• A new advisory committee should be established to integrate economic considerations into the selection process.
• These changes aim to create a more consistent, evidence-based, and ethically sound framework for policy makers.