Comment by Don McCanne
It seems intuitive that value-based insurance design (VBID), such as requiring much higher
patient cost sharing for low-value care (e.g., much greater
out-of-pocket payments for “unnecessary” CT or MRI scans), should help
reduce our total health care spending without inducing a major negative
impact on health outcomes. But the authors of this study find that
“increased cost-sharing may lead to modest increases in overall
healthcare spending,” even though it may reduce utilization of some, but
not all, targeted services.
patient cost sharing for low-value care (e.g., much greater
out-of-pocket payments for “unnecessary” CT or MRI scans), should help
reduce our total health care spending without inducing a major negative
impact on health outcomes. But the authors of this study find that
“increased cost-sharing may lead to modest increases in overall
healthcare spending,” even though it may reduce utilization of some, but
not all, targeted services.
Thus it appears that VBID may not be a very effective tool for reducing overall health
care spending. Besides, philosophically it does not seem right that
patients must face a financial penalty for obtaining the care that their
health care professionals have recommended.
care spending. Besides, philosophically it does not seem right that
patients must face a financial penalty for obtaining the care that their
health care professionals have recommended.
If penalties were to be assigned for using low-value care, wouldn’t it be
more appropriate to apply them to the health care provider who would
profit by selling more health care services with very limited value? But
then how would you determine the threshold of what care is of value and
what isn't? Regardless, this report seems to provide an argument for
dispensing with penalties in health care.
more appropriate to apply them to the health care provider who would
profit by selling more health care services with very limited value? But
then how would you determine the threshold of what care is of value and
what isn't? Regardless, this report seems to provide an argument for
dispensing with penalties in health care.
Maybe since we haven’t had much luck with carrots and sticks, we should give
up on relying on intuition in implementing health care reform and
instead adopt a proven model that is highly effective in improving
affordability and access to health care for all - a single payer
national health program: Improved Medicare for All.
up on relying on intuition in implementing health care reform and
instead adopt a proven model that is highly effective in improving
affordability and access to health care for all - a single payer
national health program: Improved Medicare for All.
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