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PubMed · 10558130

A model for improving coverage policy decisions.

R Priester·K G Gervais·D E Vawter
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Abstract

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.

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Decision MakingEfficiency, OrganizationalEligibility DeterminationHealth Care RationingHumansInsurance CoverageModels, OrganizationalOrganizational PolicyRescue WorkSocial JusticeUnited StatesJournal ArticleResearch Support, Non-U.S. Gov't

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R Priester, K G Gervais, D E Vawter. 1999. A model for improving coverage policy decisions.. https://pubmed.ncbi.nlm.nih.gov/10558130/

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