Monday, June 1, 2009

What is "Value-based" health insurance coverage?

I read this the other day:

Sen. Hutchinson touts value-based healthcare insurance coverage. In an op-ed in the Houston Chronicle (5/28), Sen. Kay Bailey Hutchinson (R-TX) wrote that rising healthcare costs "threaten the competitiveness of businesses in Texas and across the country and place an added burden on families who are struggling to make ends meet. Furthermore, our state and the federal government cannot indefinitely sustain the soaring cost of entitlement programs, like Medicare and Medicaid, which have helped ensure low-income and elderly Americans receive care...One of the most promising new concepts in health care delivery is Value Based Insurance Design, which offers the potential to simultaneously improve health care quality while reducing costs." This concept "embraces the simple yet transformative idea that cost barriers should be removed for 'high-value' prescriptions and treatments. A medicine or procedure is deemed high-value when evidence shows that we can maximize the health benefits to patients compared to dollars spent."



Why is this "transformative?" I've always wondered why treatments weren't covered for necessary medicines etc...that would keep people healthy and out of the hospital (which costs a lot more). Hepatitis vaccine isn't covered, but hepatitis treatment is. Stuff like that. So "value-based" healthcare basically says that a medicine or procedure has a huge benefit relative to dollars spent.


While I agree this should be done, I ask, why is this idea transformative? It is simple common sense. I guess not so common in the political arena.


Of course, I have noted potential for problems in the wording. What do they mean by "maximize?" I would use the definition: The value of a procedure or medicine is maximal if were that done, a higher cost medicine or procedure or admission to hospital will no longer be required.


Of course, that is what I would do. I would not put it past congress to do something completely different and render this good idea useless.

2 comments :

  1. You have it right! Congress will twist and distort a great idea into a pile of rubble..

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  2. Cynthia StephensonJune 8, 2009 at 7:36 AM

    You make some great points. I hope your blog makes it to Washington!

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