Ganther Julie M
Division of Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City 52242, USA.
J Am Pharm Assoc (Wash). 2002 Nov-Dec;42(6):875-9. doi: 10.1331/108658002762063736.
To describe three models of how health insurance coverage can develop for health care goods and services and apply them to pharmacist services. Also, to raise readers' awareness of the costs/tradeoffs involved in receiving third party reimbursements of insurance coverage from a health provider perspective.
Insurance theory and literature.
The three models for developing health insurance coverage are the risk-pooling model, the demand model, and the cost containment model. The risk-pooling model does not apply to coverage for pharmacist services because the cost of such services is not catastrophic and unpredictable. Applying both the demand model and the cost containment model to developing coverage for pharmacist services presents some challenges, but the demand model has been used more successfully to obtain insurance coverage for other health care goods and services. Potential costs and tradeoffs to the health care provider associated with insurance coverage are higher administrative costs, lower reimbursement rates, and loss of professional autonomy.
If pharmacists want to increase third party coverage for their services, the best approach may be to increase patient demand for insurance coverage by promoting and charging for pharmacist services. However, pharmacists should seriously consider whether the benefits of such coverage for their services outweigh the costs.
描述三种医疗保险覆盖医疗保健产品和服务的发展模式，并将其应用于药剂师服务。同时，从医疗服务提供者的角度提高读者对获得保险第三方报销所涉及的成本/权衡的认识。
保险理论与文献。
医疗保险覆盖范围发展的三种模式是风险共担模式、需求模式和成本控制模式。风险共担模式不适用于药剂师服务的覆盖范围，因为此类服务的成本并非灾难性且不可预测。将需求模式和成本控制模式应用于药剂师服务覆盖范围的发展存在一些挑战，但需求模式在为其他医疗保健产品和服务获得保险覆盖方面应用得更为成功。与保险覆盖相关的医疗服务提供者的潜在成本和权衡包括更高的管理成本、更低的报销率以及专业自主权的丧失。
如果药剂师希望增加其服务的第三方覆盖范围，最佳方法可能是通过推广药剂师服务并收费来增加患者对保险覆盖的需求。然而，药剂师应认真考虑此类服务覆盖的好处是否超过成本。
