A model for improving coverage policy decisions.
Reasoned and defensible coverage decisions are essential for a fairer and more efficient healthcare system. Because healthcare resources are finite, coverage decisions should be informed by economic evaluations and made from a perspective that attends to the interests of both individuals and the population enrolled in a plan as a whole. Coverage decisions for all healthcare interventions should follow a 2-step procedure that consists of (1) the relatively impartial and objective assessment of an intervention's eligibility for coverage and (2) the distinctively value-laden determination (for which the enrolled population's values and preferences should take priority) to cover, conditionally cover, or not cover an intervention.
Priester
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Minnesota Center for Health Care Ethics, Minneapolis, USA. rjpriester@worldnet.att.net
Gervais
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Vawter
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D003657:Decision Making; D017598:Efficiency, Organizational; D004608:Eligibility Determination / Q000145:classification / Q000379:methods*; D015276:Health Care Rationing / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage; D017146:Models, Organizational; D016134:Organizational Policy; D018635:Rescue Work / Q000191:economics; D012935:Social Justice; D014481:United States