Essential Health Benefits: Balancing Affordability and Adequacy
description
Transcript of Essential Health Benefits: Balancing Affordability and Adequacy
![Page 1: Essential Health Benefits: Balancing Affordability and Adequacy](https://reader036.fdocuments.net/reader036/viewer/2022062520/56816330550346895dd3af69/html5/thumbnails/1.jpg)
Essential Health Benefits: Balancing Affordability and Adequacy
John Santa MD MPHDirector, Health Ratings CenterConsumer ReportsFebruary 3, 2012
![Page 2: Essential Health Benefits: Balancing Affordability and Adequacy](https://reader036.fdocuments.net/reader036/viewer/2022062520/56816330550346895dd3af69/html5/thumbnails/2.jpg)
12. Consumer Reports employee
RA
ER
T
![Page 3: Essential Health Benefits: Balancing Affordability and Adequacy](https://reader036.fdocuments.net/reader036/viewer/2022062520/56816330550346895dd3af69/html5/thumbnails/3.jpg)
Systems are perfectly designed to get the results they achieve.
![Page 4: Essential Health Benefits: Balancing Affordability and Adequacy](https://reader036.fdocuments.net/reader036/viewer/2022062520/56816330550346895dd3af69/html5/thumbnails/4.jpg)
Key Decisions Already Made
• Should health insurance be market based?
• If market based should we enable/encourage competition?
• Should that competition include price/cost?
![Page 5: Essential Health Benefits: Balancing Affordability and Adequacy](https://reader036.fdocuments.net/reader036/viewer/2022062520/56816330550346895dd3af69/html5/thumbnails/5.jpg)
IOM Essential Health BenefitsPrinciples for Proceeding
• Economics• Ethics• Evidence based practice• Population health
![Page 6: Essential Health Benefits: Balancing Affordability and Adequacy](https://reader036.fdocuments.net/reader036/viewer/2022062520/56816330550346895dd3af69/html5/thumbnails/6.jpg)
Functional Competition
• Level playing field– What is promised---benefits– What it costs---premium, cost share– What is delivered---access, quality
![Page 7: Essential Health Benefits: Balancing Affordability and Adequacy](https://reader036.fdocuments.net/reader036/viewer/2022062520/56816330550346895dd3af69/html5/thumbnails/7.jpg)
Benefits
• Adequacy– Precise, understandable benefit language– Clear cut limits and exclusions– Understandable key definitions– Metric that expresses benefit value
• Affordability– Precise, understandable price language– Metric that expresses impact of cost sharing
![Page 8: Essential Health Benefits: Balancing Affordability and Adequacy](https://reader036.fdocuments.net/reader036/viewer/2022062520/56816330550346895dd3af69/html5/thumbnails/8.jpg)
“When you’re through learning, you’re through.”
John WoodenFormer UCLA basketball coach