Stakeholders of all stripes are at near-consensus on the importance of adequate health care coverage for all Americans. To date, steadily rising costs and the expanding ranks of the uninsured have led policymakers to concentrate on how to finance universal coverage. Communities and states that have succeeded in developing a workable financing structure are now faced with the equally challenging task of constructing a benefits package that is fair, affordable, and sustainable.
In order to create viable coverage models, we must examine certain assumptions: that all health care has value and must be covered; that insurance is to pay for services rather than to meet agreed-upon health care needs; and that the priorities of the individual trump the priorities of society. It is unlikely that expanded coverage plans -- whether at the community, state, or national level -- will be sustainable without questioning these widely held assumptions.
There are four key strategies for developing a benefits package in an era of health reform. Each can be considered independently or in various combinations.
The task for policymakers is to find the appropriate mix of these four strategies commensurate with populationbased needs, finite resources, and community values. While the question of public values has not been a routine part of the health debate, some communities have used citizen engagement tools to help define the specifics of coverage. Small group interactive methods like CHAT® transcend the limitations of public opinion surveys to help us understand what people value and why.
While medical science has a seemingly boundless capacity to offer improvements in health care, society does not have a boundless capacity to pay. The task of expanding coverage responsibly and fairly requires policymakers to make decisions that take into account the voices of those who will benefit from the coverage and the larger society that will finance it.
This paper discusses benefits design as an essential element of health care reform and as indispensable to achieving cost containment. It presents various strategies for crafting less costly high-value coverage, cites examples of health plans that have done so, and proposes a process that can build consensus for creating sustainable benefits packages.
For the complete paper, please see the PDF file attached below.