Employers Playing Doctor

It’s part of a trend toward “value-based design.” But whose values are being pushed?

Employees with certain conditions — asthma, congestive heart failure, diabetes, depression, heart disease, chronic bronchitis or emphysema — would get prescription drugs and visits with physicians free or at greatly reduced rates. High blood pressure, another common condition, would qualify for low-cost care if it was part of an overall diagnosis of heart disease.

Conversely, they’d pay much more if they have a treatment or test from a list of about 20 broad categories, including knee or hip replacement, cardiac bypass surgery, artery-opening stents, hysterectomies, high-tech-imaging exams or emergency room visits. In those cases, they’d pay double the annual deductible, double the amount they’d normally pay for an office visit and up to half the cost of hospital or ER visit, up to the $1,500/$3,000 maximums.

Comments (7)

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  1. Bruce says:

    Why don’t they just cut through the crap and pay people not to have their hip and knee replacements? I can make no sense of the categories listed above.

  2. Brian Williams. says:

    What’s next? Green medicine? Think of all the energy we could save if we dimmed the lights in operating rooms and quit using internal combustion engines in ambulances.

    Are these the same people who are trying to ban salt?

  3. Devon Herrick says:

    I don’t have a problem with insurers experimenting with different levels of cost-sharing for different conditions. Discovery Health did this with MSAs in South Africa. On the other hand, I have a big problem when politicians try to force insurers to provide certain preventive services for free (most of which don’t actually extend life or save money). Politicians should not be in the business of designing insurance plans. They don’t have the expertise.

  4. Linda Gorman says:

    Anyone that thinks that being crippled and in a wheelchair is a better value than a hip replacement or a stent must be on a government payroll.

    It makes sense that this is being trialed in Oregon–the state where Medicaid has determined that value based means that paying for tobacco cessation and abortion is more important than treating someone’s cancer.

  5. artk says:

    It’s the perfect consumer driven health care, rich consumers get good care, poor consumers get lousy care.

  6. Ken says:

    artk, this is not consumer driven health care. It is employer driven health care. Or, the way things are going, it may become government driven health care.

  7. Bruce says:

    Why don’t we call it “employer rationed care”?