Speaker: Frank Wharam MD MPH, Division of Health Policy and Insurance Research, Harvard Medical School & Harvard Pilgrim Health Care Institute.
Writer: Christiane Zhao
There are 59% of people in the United States had private health insurance in 2018, and 49% are employer-sponsored insurance. However, the high costs and suboptimal quality remains a significant issue to resolve. It is urgent to develop a high-deductible health plan and value-based health insurance strategies to support system efficiency and delivery of quality care to the population. If we place value and cost in scale, it was evident that high-value care & high-cost model can lead to a different direction compared with high-value & low-cost model.
By using diabetes as an example, Frank differentiates the models by its focus of care. High valued-based & high-cost insurance models mean it will focus more on outpatient visits for acute complications and macrovascular disease testing and treatment. Such a focus means a higher out-of-pocket cost, and it leads to a considerable delay in outpatient complication visits for low-income diabetes patients. It also appears to be increasing visit to the emergency department in the hospital, and higher severity of hospitalisation stays — the overall population results in a delay of accessing care.
In contrast, the shift to a high valued based & low-cost insurance models can positively benefit the low-come groups and further reduce inequalities in the population. Such a model means it focuses more on secondary preventive tests and cardiovascular medication use. While disease monitoring remains unchanged, the medication use declines to a small degree. When the Full VBID(cost of drugs goes down), the lower-income group has over 15.6% increases in the use of their medication to control diabetes. Not to mention, both models do not affect the high-income groups statistically, in general. However, lower out of pocket cost for medication and preventive disease monitoring can lead to a higher return on investment for the population as a whole.
Declaimer: This article is generated based on a talk given at the 9th US-CHina Health Summit in Boston, the United States in 26th September 2019. The views and opinions expressed in this article only reflect the speaker’s opinion and does not necessarily reflect the author’s official policy or position. All rights reserved.