Connecting value and costs: whom do we ask, and what do we ask them?

Article Abstract:

All authorities agree that the rate of increase of health care costs in the United States must be controlled. Beyond that, the agreement ends. At least part of the problem stems from the fact that everyone wishes to have the best care available, regardless of the cost, but few are willing to recognize, or accept, the actual price of the latest drugs and medical technology. One approach may be to connect, or reconnect, if you prefer, the value of medical care with its cost. This may be done by surveying the public with a series of questions that must be precisely designed if the proper answers are to be determined. For example, "Would you be willing to pay $50 per year extra to be guaranteed a treatment that would reduce your chance of death by one percent if you have a heart attack?" Or, "Imagine you've just had a heart attack. Would you pay $10,000 for a treatment that will reduce your chance of death by one percent?" The author recognizes that the methodological problems of designing a series of questions that will accurately reflect the wishes of the public. He suggests, however, that the current system of health insurance is, in essence, asking, "If a new drug would reduce your risk of death of a heart attack by one percent and costs you nothing, would you want it?" (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Economic aspects, Medical care, Cost of, Health care costs, editorial

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Cost-effectiveness analysis: will it be accepted?

Article Abstract:

Cost-effectiveness analysis is a way of determining the benefits of a treatment compared to its cost. But it may run counter to a doctor's clinical judgement because a less expensive treatment could be given a higher priority even though it is less beneficial. Cost-effectiveness analysis is a new technique that requires abstract thinking and mathematics, which could be difficult for some people. In addition, there are philosophical problems, such as whether it is more appropriate to focus on the health of a population than the health of one individual. It is also unclear who should decide which treatments are more beneficial. Doctors usually focus on the patients they are treating, and may be unable to prioritize the health needs of a population. Some health care professionals may not agree that health care resources are limited. But many patients, employers and insurers do feel that resources are limited, and cost-effectiveness analysis may be the only way to set priorities.

Methods, Evaluation, Cost benefit analysis, Health care rationing

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Benefit language: criteria that will improve quality while reducing costs

Article Abstract:

Proposed coverage criteria for all health care plans were formulated at a workshop sponsored by the National Institute for Health Care Management. Coverage criteria is the part of the benefit language in a health care plan that tells patient and doctor what services will be covered and which will be excluded. Many plans use the phrases 'medically necessary and appropriate' and 'reasonable and necessary', but these are ambiguous and open to interpretation. A more reasonable standard is to cover all medical treatments that have been shown to be effective by peer-reviewed, controlled clinical trials that are reproducible. The treatment's beneficial effects must outweigh its side effects and it must be the most cost-effective treatment. Services for conditions that are not considered diseases, such as pregnancy, could be automatically included. Cost-effectiveness may be the most difficult standard to implement because it implies rationing.

Managed care plans (Medical care), Terminology

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