商品簡介
As requested by the US Department of Health and Human Services, the Institute of Medicine's Committee on Defining and Revising an Essential Health Benefits Package for Qualified Health Plans outlines a process and criteria for defining, monitoring, and updating the set of benefits that must be offered to individuals and small groups in state-based purchasing exchanges and the existing market as mandated by the Patient Protection and Affordable Care Act (ACA). The committee focused on balancing the comprehensiveness of benefits with their cost. It contends that the initial package should be a modification of what small employers are currently offering and should be improved over time, and recommends that it take into account the 10 general categories of the ACA, apply committee-developed criteria to guide content and methods to determine the package, and develop an initial package within a premium target. In addition, the committee addresses medical necessity and the emphasis on evidence-based research. The report discusses how the package will impact the health insurance system; approaches to covered benefit definition and design; the policy foundations and criteria the committee used to guide deliberations and for defining and updated benefits; and conclusions about the provisions in the ACA that provide conflicting direction for essential benefits. Also covered is the definition of the package and the nature of guidance to insurers and exchanges; an approach to public deliberation for tradeoffs among benefits; the importance of learning from implementation and planning in advance through data collection and research with guidance from an appointed National Benefits Advisory Council; alternative ways of defining essential health benefits through a state-initiated process; and updating the package. There is no index. Annotation c2012 Book News, Inc., Portland, OR (booknews.com)
