1 / 9

Essential Health Benefits: Balancing Affordability and Adequacy

Essential Health Benefits: Balancing Affordability and Adequacy. John Santa MD MPH Director, Health Ratings Center Consumer Reports February 3, 2012. R. 12. Consumer Reports employee. A. T. E. R. Systems are perfectly designed to get the results they achieve.

grazia
Télécharger la présentation

Essential Health Benefits: Balancing Affordability and Adequacy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Essential Health Benefits: Balancing Affordability and Adequacy John Santa MD MPH Director, Health Ratings Center Consumer Reports February 3, 2012

  2. R 12. Consumer Reports employee A T E R

  3. Systems are perfectly designed to get the results they achieve.

  4. Key Decisions Already Made • Should health insurance be market based? • If market based should we enable/encourage competition? • Should that competition include price/cost?

  5. IOM Essential Health BenefitsPrinciples for Proceeding • Economics • Ethics • Evidence based practice • Population health

  6. Functional Competition • Level playing field • What is promised---benefits • What it costs---premium, cost share • What is delivered---access, quality

  7. 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

  8. “When you’re through learning, you’re through.” John Wooden Former UCLA basketball coach

  9. John Santa MD MPHConsumer Reports HealthDirector, Health Ratings Centersantjo@consumer.org914-378-2455

More Related