The Essential Work of Defining Essential Healthcare Benefits
Applying evidence to benefit coverage. Stakeholder comments to the IOM committee were united in support of using medical evidence to decide what benefits should be covered in an essential healthcare package. But what evidence should be standardized? Should there be flexibility so as not to limit access to care? How should evidence be used to assess new technologies? Age and chronic illnesses also come into play. The IOM has it hands full here.
I asked a few stakeholder groups what they would like to see from the IOM’s review.
Ethan Rome, executive director of Health Care for America Now, a grassroots group affiliated with the Obama administration’s healthcare reform efforts, says a specific list of essential medical benefits would be a bad idea. “The final rules must ensure that consumers get good benefits, not mini-med plans that burden families and businesses with outrageous medical costs and force them into bankruptcy,” he told HealthLeaders Media.
Dave Lemmon, director of communications for Families USA, a nonprofit advocating for consumers, says the organization would like an essential benefits package to “recognize the importance of coverage for disease management services that can help people stay healthy, save money, and avoid more expensive interventions.”
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