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Essential Health Benefits: Balancing Affordability and Adequacy

Essential Health Benefits: Balancing Affordability and Adequacy. John Santa MD MPH Director, Health Ratings Center Consumer Reports February 3, 2012. R. 12. Consumer Reports employee. A. T. E. R. Systems are perfectly designed to get the results they achieve.

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Essential Health Benefits: Balancing Affordability and Adequacy

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  1. Essential Health Benefits: Balancing Affordability and Adequacy John Santa MD MPH Director, Health Ratings Center Consumer Reports February 3, 2012

  2. R 12. Consumer Reports employee A T E R

  3. Systems are perfectly designed to get the results they achieve.

  4. Key Decisions Already Made • Should health insurance be market based? • If market based should we enable/encourage competition? • Should that competition include price/cost?

  5. IOM Essential Health BenefitsPrinciples for Proceeding • Economics • Ethics • Evidence based practice • Population health

  6. Functional Competition • Level playing field • What is promised---benefits • What it costs---premium, cost share • What is delivered---access, quality

  7. Benefits • Adequacy • Precise, understandable benefit language • Clear cut limits and exclusions • Understandable key definitions • Metric that expresses benefit value • Affordability • Precise, understandable price language • Metric that expresses impact of cost sharing

  8. “When you’re through learning, you’re through.” John Wooden Former UCLA basketball coach

  9. John Santa MD MPHConsumer Reports HealthDirector, Health Ratings Centersantjo@consumer.org914-378-2455

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