Value-based insurance. “If patients insist on medical procedures that science shows to be ineffective or unnecessary, they'll have to pay for all or most of the cost.”
by JONATHAN M. METSCH, DR.P.H., LLC
May 02, 2014 | 432 views | 0 0 comments | 3 3 recommendations | email to a friend | print
We all “demand” tests and prescriptions from out doctors and it is often easier for them to comply than argue. Now there may be a price to pay.

Recently, a Reuters article http://www.reuters.com/news * reported on “value-based” insurance with this vignette:

“When Tanner Martin, 17, developed excruciating back pain last year, he was sure he needed an X-ray to find out what was wrong. So was his mother, who worried that the pain might indicate a serious injury that could cause permanent disability.

In Tanner's case, when he and his mother went to the medical center, they were invited to watch a short video first. The best approach to back pain like Tanner's, it explained, is stretching, strength-building and physical therapy; X-rays and MRIs, according to rigorous studies, are unlikely to make a difference. If they insisted on the X-ray, they would have to pay $300 on top of the basic cost.

They passed on the imaging, knowing they could change their minds if Tanner's condition worsened. After three weeks of therapy, his back was as good as new.

"My assumption was that a back injury was always severe, needing intervention," Martin said. "I was very misinformed about the need for imaging."

The additional cost when patients choose procedures that research shows are unlikely to help their condition is a key element of San Luis Valley's two-year experiment in value-based insurance, the premise of which is that a mix of financial carrots and sticks can steer patients toward medical services that will help them and away from ineffective or unnecessary ones.

*to read the full Reuter’s article “In healthcare experiment, patients pay more for 'bad' medicine” by Sharon Begley, highlight and click on open hyperlink http://www.reuters.com/article/2013/12/19/us-usa-healthcare-insurance-idUSBRE9BI04X20131219

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