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Wednesday, 06 November, 2019

Ted's Take: Mandated Benefit Review Panel

Historically, the State of Maryland has mandated that all insurers writing health insurance in the state include so called “mandated benefits” in their insurance packages. A while back I was one of the panelists that heard evidence regarding potential benefits and who’s responsibility was to recommend whether such benefit should be included or not included  in the mandate. This experience offers some insights into the current health care coverage debate.

 

The situation 

At the time, the panel was reviewing five new potential benefits to be added to the mandate of which only one would be approved. As examples, one benefit was for an expansion of cardiac care, another was for radiology coverage, etc. The one focused on below was for an expansion of preventive care for children. The presenter for this expansion was a physician who was the then current president of the Maryland Society of Pediatrics who coincidentally happened to be a neighbor of mine. His was the last presentation attempting to justify the inclusion of the coverage into the benefit package. At the end of his presentation, I asked him only one question: “Why is your proposal better than the other four that have been presented from a benefit and cost perspective?"

He had no real response. In fact, he kind of fumbled and dodged the question because he did not want to say anything negative about the other proposals. His suggested expansion failed to get approved and while he’s still a neighbor, he never spoke to me again.

 

The essence of my question was I needed him to help me make the decision as to which of the options was the most valuable, from a cost/benefit perspective.

 

 

Take-a-ways

Here are a few “take-a-ways’ from this example.

 

  • Not all benefits should be included. The broader the benefit package, the greater the cost. Some things just can’t be included.

     

  • If the benefit package is too large, buyers of coverage can become insurance poor because the cost is too high.

     

  • Each decision must be examined from a cost and benefit perspective given that we are in times of scarce resources.

     

  • Healthcare coverage and life is about choices, many of which are mutually exclusive. If we view decisions as if resources are unlimited, the decision is easy. Unfortunately, that is not the case (although politicians often avoid this).

 

In my view, the above take-a-ways should guide us in making our health policy decisions as we cannot afford to include every possible benefit within insurance coverage.

 






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