Bioethics Blogs

My New JAMA Article, On Value Promotion in Healthcare

Here is the opening of an article I recently published in JAMA, available now online, in which I raise concerns about misguided congressional efforts to promote the use of high-value healthcare services, without doing anything to reduce the use of low value ones.

Health care systems around the world are under pressure to restrain health care expenditures. In response, many health care leaders have embraced the idea of promoting health care value, with value defined “as the healthcare outcomes achieved per dollar spent.”1 For instance, some experts have urged third-party payers to adopt value-based insurance designs, whereby the amount patients pay out-of-pocket for health care services varies not as a function of the cost of those services but, instead, as a function of their value.2

The US Congress also has expressed support for value promotion, with both the House and the Senate passing legislation requiring the Centers for Medicare & Medicaid Services to pilot test value-based insurance designs in Medicare Advantage plans (the private insurance plans that contract with Medicare to provide enrollees with health care benefits).

Although advocates of value-driven health care may embrace the idea of value-based insurance designs, the proposed Medicare Advantage pilot is likely too asymmetrical to create many savings. The bills promote the use of high-value health care services without creating strategies to reduce the use of low-value ones. Unless value-based insurance programs in particular, and value promotion more generally, are balanced, they are unlikely to restrain health care expenditures.

To understand the hazards of this asymmetry, it helps to clarify how value-based insurance programs differ from the design of some traditional insurance benefits.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.