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Value-based insurance design (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. The costs saved by VBID could be used to subsidize coverage for the currently uninsured, providing a substantial improvement in health outcomes.
Strategies that influence the quantity of health care consumed are essential to controlling healthcare costs. Such strategies can target health care providers or can target consumers by charging co-payments and out-of-pocket deductibles. Cost sharing decreases health expenditure 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 – the additional health benefit it adds per dollar spent – rather than its cost. 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, the researcher R. Scott Braithwaite and colleagues estimated that approximately 60 percent of health expenditures in the US are spent on low-value services and 20 percent are spent on high-value services, indicating that the vast majority (80 percent) of health expenditures would have cost sharing that would be affected by VBID.
They found that 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 percent increase.
MEDICA.de; Source: Public Library of Science