Health Insurance Benefits Should Be Equitable, Not Necessarily Equal

As policy makers grapple with potentially undoing or modifying the largest expansion of health insurance in a generation, the cost and generosity of benefits hold center stage. Traditional underpinnings of insurance plans—premiums, deductibles, copayments, and coinsurance—frequently create barriers to the optimal use of these plans by consumers. They also can exacerbate inequities in health care, by inhibiting the use of services known to benefit health. Novel approaches to insurance plan design to produce a more equitable and efficient distribution of health care expenditures are warranted. Following the principle of equality, insurance benefit designs traditionally have offered the same benefit structure to all enrollees. Consumer cost sharing at the point of service is typically uniform regardless of need or potential clinical benefit—often it’s based on the acquisition cost. This one-size-fits-all mentality seems like a great idea on the surface but can create deeply unfair outcomes. For example, in a traditional tiered pharmacy benefit, patients have the same out-of-pocket cost for a life-saving cardiac drug as they do for a medication that treats an annoying, but ultimately benign, toenail fungal infection. Or, a patient with a chronic disease enrolled in a high-deductible health plan must pay the full cost of medications and supplies to control their illness until the plan deductible is met, reducing adherence to treatments that keep people healthie...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Health Equity Insurance and Coverage health insurance benefits insurance plan design value-based insurance design Source Type: blogs