Powell Adam, Dolan Paul
Payer+Provider Syndicate, Newton, MA, United States.
London School of Economics and Political Science, London, United Kingdom.
J Particip Med. 2022 Aug 4;14(1):e35798. doi: 10.2196/35798.
When individuals, families, and employers select health plans in the United States, they are typically only shown the financial structure of the plans and their provider networks. This variation in financial structure can lead patients to have health plans aligned with their financial needs, but not with their underlying nonfinancial preferences. Compounding the challenge is the fact that managed care organizations have historically used a combination of population-level budget impact models, cost-effectiveness analyses, medical necessity criteria, and current medical consensus to make coverage decisions. This approach to creating and presenting health plan options does not consider heterogeneity in patient and family preferences and values, as it treats populations as uniform. Similarly, it does not consider that there are some situations in which patients are price-insensitive. We seek to highlight the challenges posed by presenting health plans to patients in strictly financial terms, and to call for more consideration of nonfinancial patient preferences in the health plan design and selection process.
在美国，当个人、家庭和雇主选择健康保险计划时，他们通常只能看到这些计划的财务结构及其提供商网络。这种财务结构的差异可能会导致患者选择与他们的财务需求相符，但与他们潜在的非财务偏好不符的健康保险计划。使这一挑战更加复杂的是，管理式医疗组织历来使用人口层面的预算影响模型、成本效益分析、医疗必要性标准和当前医学共识的组合来做出承保决定。这种创建和呈现健康保险计划选项的方法没有考虑患者和家庭偏好及价值观的异质性，因为它将人群视为同质化的。同样，它也没有考虑到在某些情况下患者对价格不敏感。我们试图强调以严格的财务术语向患者呈现健康保险计划所带来的挑战，并呼吁在健康保险计划的设计和选择过程中更多地考虑患者的非财务偏好。
