Mich Law Rev. 2014 Feb;112(4):523-74.
With the Patient Protection and Affordable Care Act ("ACA") set to dramatically increase access to medical care, the problem of rising costs will move center stage in health law and policy discussions. "Consumer directed health care" proposals, which provide patients with financial incentives to equate marginal costs and benefits of care at the point of treatment, demand more decisionmaking ability from consumers than is plausible due to bounded rationality. Proposals that seek to change the incentives of health care providers threaten to create conflicts of interest between doctors and patients. New approaches are desperately needed. This Article proposes a government-facilitated but market-based approach to improving efficiency in the private market for medical care that I call "relative value health insurance." This approach focuses on the "choice architecture" necessary to enable even boundedly rational patients to contract for an efficient level of health care services through their health insurance purchase decisions. It uses comparative effectiveness research, which the ACA funds at a significant level for the first time, to rate medical treatments on a scale of one to ten based on their relative value, taking into account expected costs and benefits. These relative value ratings would enable consumers to contract with insurers for different levels of medical care at different prices, reflecting different cost-quality trade-offs. The Article describes both the benefits of relative value health insurance and the impediments to its implementation. It concludes with a brief discussion of how relative value ratings could also help to rationalize expenditures on public health insurance programs.
随着《患者保护与平价医疗法案》（“ACA”）的实施，医疗服务的可及性将大幅增加，成本上升问题将成为医疗保健法律和政策讨论的焦点。“消费者导向型医疗保健”提案为患者提供了在治疗点衡量医疗成本和收益的经济激励，这要求消费者具备比有限理性更合理的决策能力。寻求改变医疗服务提供者激励机制的提案有可能在医生和患者之间造成利益冲突。迫切需要新的方法。本文提出了一种政府协助但基于市场的方法，旨在提高医疗保健私人市场的效率，我称之为“相对价值健康保险”。这种方法侧重于“选择架构”，使即使是有限理性的患者也能够通过其医疗保险购买决策来签订有效的医疗服务合同。它利用 ACA 首次在相当大的程度上资助的比较效果研究，根据其相对价值，对医疗进行一到十分的评分，同时考虑预期成本和收益。这些相对价值评分将使消费者能够与保险公司以不同的价格签订不同水平的医疗保险合同，反映不同的成本-质量权衡。本文描述了相对价值健康保险的好处以及实施它的障碍。最后简要讨论了相对价值评分如何帮助公共医疗保险计划的支出合理化。
