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Health Care Reform:

Health Insurance & Affordable Care Act

Next Big Benefit Change: 7 Things You Should Know

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6) BUT DON’T HIGHER PRICES MEAN HIGHER- QUALITY SERVICES?

No, most studies have found that higher prices do not necessarily mean higher quality care, but consumer groups are concerned that insurers and employers rank quality, as well as cost of different providers. That might be difficult since there may be little information comparing the quality of one provider with another for many procedures, such as colonoscopies. CalPERS gathered data on joint replacement when it set up its reference price system, finding no differences among high- and low-priced facilities when considering measures such as infection and readmission rates, according to a report from the Center for Studying Health System Change, a nonpartisan Washington, D.C. think tank. In its first year, the system had 45 hospitals meeting the reference price, and that grew to 54 in the second year.

7) WHAT HAPPENS NEXT?

The administration has asked for comments on reference pricing by Aug. 1, including suggestions for standards to ensure “meaningful access to medically appropriate, quality care.”

Sabrina Corlette, project director at the Health Policy Institute at Georgetown University, said the government needs to provide clearer guidelines for employers and insurers about how to explain the choices under reference pricing, which she says “put a fairly large burden on the consumer to understand.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Fri, May 23 2014

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