Value-Based Insurance Design Aligning Incentives to Improve Cardiovascular Care

摘要

Over the past 50 years, the costs of American medical care have increased dramatically. Although these high costs have been accompanied by substantial reductions in morbidity and mortality, Americans could derive significantly more value from healthcare expenditures.1 For many policy makers, the major focus of healthcare reform has centered on methods to improve economic efficiency - the outcomes achieved relative to per capita healthcare spending. A more recent emphasis on patient-centered care has added growing awareness of the importance of accommodating individual patients' preferences, needs, and beliefs into health care.2 Value-based insurance design (V-BID) describes a system of health insurance that varies patients' cost sharing to maximize the use of high-value services while maintaining a focus on patient centered-ness. This review addresses aspects of V-BID that are relevant to cardiovascular medicine: fundamental features, evidence for effectiveness, real-world applications, novel ways to build on strengths, relevance in future health policy landscapes, and known limitations.