Value-Based Insurance Design

A value-based insurance design is a health insurance policy where selection of services and payment for services are decided by evaluating clinical benefit as well as cost, where decision making is condition specific if not patient specific, and where the evaluation process takes into consideration multiple time periods. It is not the value of the service to the provider, the clinical developer, or the payers that matters but the clinical benefit and costs to the patient and society. Value-based insurance design offers a potential solution to the healthcare-financing crisis. The concept of value, defined as the clinical benefit achieved for the money spent, is largely absent from most insurance policies and design discussions but is perhaps the most important aspect of insurance for purchasers and ...

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