Coverage

Coverage

Insurers and governments can influence the cost of a system through the level of coverage they make available.

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A key tenet of the US healthcare reforms, for example, is to expand the size of the insurance pool, particularly for younger, professional individuals currently uncovered, through an insurance mandate for all citizens. One commonly discussed approach is to define a package of health services that will reflect the priorities identified. Another might be to simply finance or provide services identified as priorities, including those included on a list.

The figure below outlines some key options, or configurations, that may be considered in developing a basic package. Clearly, how a system selects the level of coverage will have important implications in the overall costs borne by the system.

Designing a package of services offers other advantages. By pooling a number of interventions, inputs can be shared, savings can be made and demand managed by improving the coordination of resources and creating incentives for prevention. It may also be effective to restrict the elements covered to reduce the use of high-cost and low-value treatments or to provide partial coverage only. This approach allows providers to focus and reduce the variability in their workload and also encourage patients to change their behaviors to choose more cost effectively.

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