Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Health Aff (Millwood). 2010 Nov;29(11):2017-21. doi: 10.1377/hlthaff.2010.0878.
Value-based insurance design improves health care quality and efficiency by reducing cost sharing for services that have strong evidence of clinical benefit. The same goals can also be accomplished by increasing cost sharing for low-value services, which would ensure more effective care and achieve net cost savings. However, there are challenges in defining what is meant by "low-value services" and implementing programs to restrict such services' use. This paper argues that investments in processes to define low-value care, comparative effectiveness research to identify services that produce harm or marginal clinical benefit, and information technology to implement findings can facilitate applying value-based insurance design to the low-value realm.
通过降低具有明确临床获益的服务的自付费用，基于价值的保险设计可以提高医疗质量和效率。通过提高低价值服务的自付费用，同样可以实现这些目标，从而确保更有效的护理并实现净成本节约。然而，定义“低价值服务”的含义以及实施限制此类服务使用的计划存在挑战。本文认为，投资于定义低价值护理的流程、开展比较效果研究以确定产生危害或边际临床获益的服务以及利用信息技术实施研究结果，能够促进基于价值的保险设计在低价值领域的应用。
