Determining Health Insurance Coverage of Technology

Problems and Options

Bibliographic Data

ID9102785
AuthorsBarbara Greenberg (0000-0002-4014-3685, Washington Center, corresponding author), Robert A Derzon
Year1981
Volume19
Issue10
Pages967-978
Publication date1981-10-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-198110000-00001
PMID6796788
OpenAlexW2025893901
LanguageEN
Citations received2
References cited1

By deciding which medical procedures are eligible for reimbursement, health insurance programs possess the potential to affect significantly technology use and health care spending. Traditionally, insurers have adopted a passive stance and made relatively few negative coverage determinations. However, resistance to rapidly rising costs has created a powerful inducement for third-party payors to become more prudent purchasers of health care services. Consequently, both Medicare and Blue Cross--Blue Shield are considering the implementation of changes that may ultimately result in more restrictive coverage decisions. This article examines the coverage process of Medicare and Blue Cross--Blue Shield and the policy changes that both programs are considering. In addition, it discusses the strengths and drawbacks of four coverage policy options: restricting insurance coverage of unproven procedures, introducing cost-effectiveness criteria, educating physicians and educating consumers

Actuarial science · Business · Economic growth · Economics · Health care · Health insurance · Risk analysis (engineering) · Health Systems, Economic Evaluations, Quality of Life · Healthcare Policy and Management · Pharmaceutical Economics and Policy

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