Korobkin Russell
University of California, Los Angeles.
J Health Polit Policy Law. 2014 Apr;39(2):417-40. doi: 10.1215/03616878-2416310. Epub 2014 Feb 12.
Increases in health costs continue to outpace general inflation, and implementation of the Patient Protection and Affordable Care Act will exacerbate the problem by adding more Americans to the ranks of the insured. The most commonly proposed solutions--bureaucratic controls, greater patient cost sharing, and changes to physician incentives--all have substantial weaknesses. This article proposes a new paradigm for rationalizing health care expenditures called "relative value health insurance," a product that would enable consumers to purchase health insurance that covers cost-effective treatments but excludes cost-ineffective treatments. A combination of legal and informational impediments prevents private insurers from marketing this type of product today, but creative use of comparative effectiveness research, funded as a part of health care reform, could make relative value health insurance possible. Data deficits, adverse selection risks, and heterogeneous values among consumers create obstacles to shifting the health insurance system to this paradigm, but they could be overcome.
医疗成本的增长持续超过总体通货膨胀率，而《患者保护与平价医疗法案》的实施将使更多美国人加入被保险人行列，从而加剧这一问题。最常被提出的解决方案——官僚控制、增加患者费用分担以及改变医生激励措施——都存在重大缺陷。本文提出了一种使医疗保健支出合理化的新范式，称为“相对价值健康保险”，这种产品能让消费者购买涵盖成本效益高的治疗但不包括成本效益低的治疗的健康保险。法律和信息方面的障碍共同阻碍了私人保险公司如今推销这类产品，但作为医疗保健改革一部分获得资助的比较效果研究的创造性运用，可能使相对价值健康保险成为现实。数据不足、逆向选择风险以及消费者之间的异质价值观给将健康保险体系转向这一范式造成了障碍，但这些障碍是可以克服的。
