Explore the vast range of titles available.

Background: Cost-sharing requirements employed by health insurers to discourage the unnecessary use of medications may lead to underutilization of recommended treatment regimens and suboptimal quality of care. Value-based insurance design (VBID) programs seek to address these problems by lowering copayments to promote adherence to \"high-value\" medications that have been proven to be clinically beneficial. VBID evaluations to date have focused on programs implemented by self-insured employers. This study is among the first to assess the VBID program of a health plan. Methods: We examined a VBID program for statins implemented by a large regional health plan in 2008 and assessed its effect on medication adherence. Copayments on VBID brand statins were reduced by 42.9% for employer-sponsored plans (the treatment group) and increased by 16.7% for state-sponsored plans (the control group) between the preintervention and postintervention periods. Propensity score weights were used to balance the treatment and control groups on observed characteristics. We evaluated the impact of the VBID program on adherence using an econometric model with a difference-in-difference design. Results: Medication adherence increased 2.7 percentage points (P= 0.033) among VBID brand statin users in the treatment group relative to the control group. With a baseline adherence rate of 77.6%, nonadherence was reduced by 11.9%. Conclusions: Copayment reductions on selected statin medications contributed to improvements in adherence. As one of the first studies to evaluate a health plan's VBID program, our findings demonstrate that insurer-based VBID programs may yield results similar to those achieved by employer-based programs.

Introduction Men with newly diagnosed prostate cancer often appropriately elect for either immediate treatment or conservative management. The out‐of‐pocket costs they face vary by management strategy, with immediate treatment often superseding those of conservative management, potentially influencing patient decisions. We estimated the anticipated out‐of‐pocket costs that commercially insured men with newly diagnosed prostate cancer face and measured their association with immediate treatment. Methods From MarketScan, we identified men with newly diagnosed prostate cancer from 2010–2020. Separately, using actual out‐of‐pocket costs (summing deductible, copay, coinsurance) among patients undergoing arthroscopic meniscal repair (n = 383,187), we derived regression coefficients for patient‐level variables (e.g., health plan type) that inform their financial liability. We applied these coefficients to men with prostate cancer and estimated their predicted out‐of‐pocket costs, our main exposure. We sorted patients into quartiles and used logistic regression to calculate adjusted probabilities of immediate treatment (versus conservative management). Results We identified 58,206 men with prostate cancer and rank ordered them by predicted out‐of‐pocket cost. Approximately 12% of men had a predicted out‐of‐pocket cost of zero, and among those with non‐zero cost sharing, the median out‐of‐pocket cost was$350 (IQR: $ 275, $486). Across quartiles of predicted out‐of‐pocket costs, adjusted percentages of immediate treatment were in a narrow range between 77.8% (95% CI: 76.8%, 78.8%) for Quartile 1% and 78.6% (95% CI: 77.7%, 79.5%) for Quartile 4. Conclusion Among commercially insured men with prostate cancer, predicted out‐of‐pocket costs varied substantially. However, the choice of management, immediate treatment or conservative management, appears insensitive (i.e., inelastic) to patient anticipated financial liability.

We design the insurance contract when the insurer faces arson-type risks. We show that the optimal contract must be manipulation-proof. Therefore, it is continuous, has a bounded slope, and satisfies the no-sabotage condition when arson-type actions are free. Any contract that mixes a deductible, coinsurance, and an upper limit is manipulation-proof. A key feature of our models is that we provide a simple, general, and entirely elementary proof of manipulation-proofness that is easily adapted to different settings. We also show that the ability to perform arson-type actions reduces the insured’s welfare as less coverage is offered in equilibrium.

In this paper, we consider an optimal insurance problem from the perspective of a risk-averse individual who faces an insurable risk as well as some background risk and wants to maximise the expected utility of his/her final wealth. To reduce ex post moral hazard, we follow Huberman et al. (Bell J. Econ. 14:415–426 1983) to assume that alternative insurance contracts satisfy the principle of indemnity and the no-sabotage condition. When the insurance premium is calculated by the expected value premium principle, a necessary and sufficient condition for the optimality of an insurance contract is established under a general dependence structure between insurable and background risks. By virtue of this condition, some qualitative properties of optimal contracts are developed, a scheme is provided to improve any suboptimal insurance strategy, and optimal insurance forms are derived explicitly for some dependence structures of interest. These forms are not always piecewise linear.

Traditionally, value-based health care assessment initiatives have: (1) not explicitly evaluated value; (2) been complex (which limits reproducibility) and not admitted customization; and 4) not operationalized value in a way that addresses the concerns of the involved stakeholders. This research developed a four-step framework for value-based assessment of health care services that aims to overcome these limitations. The development of the framework was supported by a case study conducted in the radiology department of the second largest general hospital in Portugal and involved the participation of administrators, physicians, radiographers, and patients, and incorporates several Multiple Criteria Decision Analysis methods. A set of 160 indicators to assess the value of radiology departments was identified in the literature and synthesized into 7 value-assessment dimensions. The framework considers specific indicators for each stakeholder type and suggests customizable ways to determine the benefit of the service. Additionally, we determined the value of the radiology department (considering benefits perceived by stakeholders and direct clinical costs) and propose a dashboard to monitor its evolution. The developed management tool enables an explicit valuation of the department and uncovers service features that need to be improved. If its use is continued, it will report the evolution of the department. The framework can easily be adapted to other hospitals or departments or be used by researchers as a basis for the development of other models.

The concept of Value-Based Health Care (VBHC) seeks to maximise patient value by optimising health outcomes considering costs. However, necessary data are not readily available. In Switzerland, hospital accounting is disconnected from patient outcomes and treatment data. We demonstrate the feasibility of merging routine hospital data, including patient-reported outcome measures (PROMs), to implement core elements of VBHC in a real-world lung cancer centre. We developed a merging approach using records from 208 newly diagnosed lung cancer patients treated at University Hospital Basel between June 2020 and November 2023. Maximum patient follow-up was 12-months. Clinician-reported outcome measure (CROM) and PROM data collection followed the International Consortium for Health Outcomes Measurement (Lung Cancer Set) standard. Cost data were extracted from Switzerland's standard hospital accounting system (REKOLE®). To illustrate analytical options offered by the merged data, we analysed partial correlations between costs and utility changes from baseline. The merging approach successfully allocated costs to specific lung cancer treatments and separated costs for comorbidity care, enabling an initial presentation of cost distributions for different elements of care. Median total first-year hospital costs per lung cancer patient were CHF 77,834 (mean CHF 93,621). Immunotherapy incurred the highest median costs of CHF 45,394 (mean CHF 49,518), followed by surgery of CHF 41,665 (mean CHF 48,940). First-year costs for patients diagnosed with stage I tended to be lower than for later stages. A standard graphical tool was developed to track individual patient treatment, outcome, and cost over time. This proof-of-concept analysis demonstrates the feasibility of a novel data merging approach as a foundation for VBHC implementation. While limited by sample size and follow-up duration, our method supports future treatment-cost-benefit models. It is reproducible and scalable across other conditions and hospitals, enabling the development of lung cancer treatments towards greater value and efficiency.

We introduce a smooth decision model under ambiguity by the belief-dependent utility (BDU) proposed in Fan (Acta Math Appl Sin 37(4):682–696, 2021). Using the smooth decision model under BDU, we get the explicit optimal insurance policy for the insurer. Then the optimal insurance policy for the insured under premium constraint (the insurer is assumed to be risk neutral) is studied. The explicit results can explain some notable behaviors in insurance demand which are inconsistent with the classical insurance contracting literature. For example, if the insured is very sensitive to small losses and the insurer is not so sensitive to small losses (or the insurer is risk neutral), the insured will prefer to purchase warranties for small losses rather than buy protections against devastating losses, which is consistent with some insurance demand behaviors observed on the insurance market. If the insured is less sensitive to small losses than the insurer, insurance policy against large losses above a deductible will be popular. At last, this paper provides an example.

Background The socioeconomic status (SES) gradient in hospital and emergency room utilization among adults with type 2 diabetes (T2DM) is partially driven by cost-related non-adherence. Objective To test the impact of the Diabetes Health Plan (DHP), a diabetes-specific health plan incorporating value-based insurance design principles on healthcare utilization among low-income adults with T2DM. Design To examine the impact of the DHP on healthcare utilization, we employed a difference-in-differences (DID) study design with a propensity-matched comparison group. We modeled count and dichotomous outcomes using Poisson and logit models, respectively. Participants Cohort of adults (18–64) with T2DM, with an annual household income <$ 30,000, and who were continuously enrolled in an employer-sponsored UnitedHealthcare plan for at least 2 years between 2009 and 2014. Interventions The DHP reduces or eliminates out-of-pocket costs for disease management visits, diabetes-related medicines, and diabetes self-monitoring supplies. The DHP also provides access to diabetes-specific telephone case management as well as other online resources. Main Measures Number of disease management visits ( N = 1732), any emergency room utilization ( N = 1758), and any hospitalization ( N = 1733), within the year. Key Results DID models predicting disease management visits suggested that DHP-exposed beneficiaries had 1.7 fewer in-person disease management visits per year (− 1.70 [95% CI: − 2.19, − 1.20], p < 0.001), on average, than comparison beneficiaries. Models for emergency room (0.00 [95% CI: − 0.06, 0.06], p = 0.966) and hospital utilization (− 0.03 [95% CI: − 0.08, − 0.01], p = 0.164) did not demonstrate statistically significant changes associated with DHP exposure. Conclusions While no relationship between DHP exposure and high-cost utilization was observed in the short term, fewer in-person disease management visits were observed. Future studies are needed to determine the clinical implications of these findings.

Objectives Value-based insurance design (VBID) aims to direct consumers’ preferences by incentivizing the use of high-value care and discouraging the use of low-value care. However, consumers often have limited knowledge of health insurance and the health insurance system, possibly distorting their preferences. In this study, we aim to investigate the impact of specific information treatments on consumers’ preferences for VBID. Methods We implemented an information experiment as part of a representative survey on health insurance literacy and preferences for VBID within Switzerland’s choice-based health insurance system. Preferences for VBID were measured through a discrete choice experiment. Cross-sectional data on 6,033 respondents aged 26–75 were analyzed using descriptive statistics and mixed logit regressions. Results Respondents showed strong preferences for their current health insurance instead of VBID alternatives. A general description of current regulations on cost-sharing, drug disbursement, and monthly premiums significantly increased preferences for VBID ( p  < 0.01). Pointing respondents specifically to VBID further reduced the opposition against VBID plans. At the same time, there is evidence for anchoring effects in copayments after receiving the information treatments, irrespective of the value of the care. Conclusions The results of this study highlight that individuals are susceptible to provided information about health insurance when building their preferences for VBID. One potential explanation is limited health insurance literacy, implying that tailored communication strategies may be needed to improve insurance decision-making. JEL Classification I11, I13. Highlights People generally prefer their current health insurance plan over alternative plans that incorporate value-based features, such as incentivizing the use of high-value care. Providing detailed information about these new types of health insurance plans shifts people’s preferences toward them, suggesting a need for more comprehensive knowledge about health insurance. The observed preference shifts underline the importance of improved communication strategies to facilitate informed decision-making in health insurance.