Designing Benefits with Evidence in Mind

Abstract:     
This paper summarizes the history of benefit design in the U.S. approach to health care; the state of research evidence currently available for use in benefit design; and past and current efforts to integrate evidence into benefit design, including the barriers encountered in these efforts and suggestions for overcoming them. It focuses especially on the need for a different benefit design language that would enable an explicit linkage between evidence and benefits. This analysis is based on a review of the literature; on one of the author's experience, which includes executive service in a BlueCross/BlueShield plan; on policymaking in state government; and on interviews with health care leaders in both the public and private sectors.

Keywords: Evidence-based medicine, Health care cost containment, Health care delivery, Health care quality, Health insurance coverage

JEL Classifications: I11

Accepted Paper Series