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Latest on Health Care Costs & Reforms

According to a recent study conducted by the PLoS Machine, value-based insurance design (otherwise known as VBID) in which consumer payments are waived for highly effective treatments, but are raised for less effective ones, could increase the benefits of healthcare in the US without increasing expenditures. This could potentially be the very answer to health reform that all Americans have been waiting for.

Health care benefits and co-payments have always worked side-by-side and been distributed equally among employees. This arrangement has worked well for many years. But is it effective? Or is VBID the answer struggling health care consumers have been longing for?

Advocates of “value-based insurance design” suggest that it makes more sense to price health care costs based on their specific value to individual patients rather than using a “one-size-fits-all” solution. The costs saved by VBID could be used to formulate coverage for the currently uninsured, providing a substantial improvement in health outcomes.

All current cost sharing programs are nearly always based on the expense of the service or medicine and rarely is related to its potential benefit to a patient. The new plan would design specific services for targeted groups of patients.

Strategies that influence the quantity of health care consumed are essential to controlling healthcare costs. Cost sharing decreases health care costs, but it can also reduce demand for essential care and thus reduce the overall quality of care.

Consequently, some experts have proposed VBID, an approach in which the amount of cost sharing is set according to the ”value” of an intervention and the additional health benefit it adds per dollar spent rather than its cost. For example: under VBID, cost sharing could be waived for office visits necessary to control blood pressure in people with diabetes, which constitute high-value care, but could be increased for high-tech scans ordered to diagnose chronic dementia.

In the current study, using computer simulations of costs and life expectancy gains based on US healthcare data, R. Scott Braithwaite of the New York University School of Medicine and colleagues, estimated that approximately 60% of health expenditures in the US are spent on low-value services and 20% are spent on high-value services, indicating that the vast majority (80%) of health expenditures would have cost sharing that would be affected by VBID.

Broader diffusion of VBID to drug costs alone increased the benefit conferred by health care by 0.03 to 0.05 additional life-years, without increasing overall costs or out-of-pocket payments. Extension of VBID to other health care services could increase the benefit conferred by health care by 0.24 to 0.44 additional life-years. Among those without health insurance, using cost saving from VBID to subsidize insurance coverage would increase the benefit conferred by health care by 1 .21 life-years, a 31% increase.

If you have any questions regarding health care insurance and live in the states of Arizona or California please visit ASJ Insurance & Financial Services Inc.’s website today (http://www.asjhealthinsurance.com) to get an instant comparative quote from several health insurance companies like Blue Cross, Blue Shield, Cigna, United Health, Health Net, Pacific Care, Kaiser, Assurant Health and many more. Or give them a call at (602) 212-1048 to discuss various options available to you.



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