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Guiding Principles for CT Health Reform

Guiding Principles for CT Health Reform. Randall R. Bovbjerg Barbara A. Ormond The Urban Institute Presented to the HealthFirst CT Authority Hartford, CT 3 April 2008. IOM PRINCIPLES. Health care coverage should be universal . Health care coverage should be continuous .

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Guiding Principles for CT Health Reform

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  1. Guiding Principles for CT Health Reform Randall R. Bovbjerg Barbara A. Ormond The Urban Institute Presented to the HealthFirst CT Authority Hartford, CT 3 April 2008

  2. IOM PRINCIPLES • Health care coverage should be universal. • Health care coverage should be continuous. • Health care coverage should be affordable to individuals and families. • The health insurance strategy should be affordable and sustainable for society. • Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.

  3. UNIVERSAL COVERAGE • motivation for people to get and keep coverage • e.g., mandate or automatic enrollment • definition of what constitutes coverage • infrastructure thru which people can get coverage • e.g., employers, insurance agents and brokers, public programs, “connectors” • assistancefor low-income and high-risk residents • e.g., public subsidy, risk spreading • sustainable funding mechanism(s).

  4. CONTINUOUS COVERAGE Requires attention to: • transitions between coverage options • e.g., income changes that trigger eligibility for public subsidy, health status changes • funding mechanism that minimizes the risk of cutbacks in the future • explicit attention to cost to maintain affordability

  5. AFFORDABLE FOR RESIDENTS Affordability is influenced by • income • health status • structure of coverage as well as premiums • co-pays, deductibles, out-of-pocket limits, lifetime limits • benefits • mental health, oral health, prescription drugs, preventive care, wellness promotion

  6. AFFORDABLE & SUSTAINABLE FOR SOCIETY • What share of the cost will be borne by the state? • How will the state share be funded? • How will funding be maintained in face of the year-to-year challenge to balance state budgets? • Cost containment and efficiency are critical for sustainability.

  7. ENHANCE HEALTH & WELL-BEING • Applies to existing coverage as well as expansions. • Financing should provide the incentives for • caregivers to provide efficient, high value care • residents to take responsibility for their health and use care wisely. • Policies that affect caregivers should be attractive enough to induce both reasonable availability of care and willingness to undertake value enhancing activities. • Providers and residents both need systematic support, including information, oversight, and feedback. • Establishing and maintaining the correct price signals will contribute to achieving high-value care.

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