Cover more for less: Targeted drug coverage, chronic disease management, and medical spending
中文摘要
扩大公共医疗保险项目面临的一项关键挑战，是如何在有限预算下以符合成本效益的方式实施这些项目。本文研究了一种基于价值的保险设计，该设计针对高血压和糖尿病这两种慢性病引入了处方药保障。这一针对特定疾病的药品保障方案增加了初级医疗服务的使用，并大幅减少了住院，从而实现了总医疗支出的可观净节约。这一过程中有三个作用渠道。第一，通过促进初级医疗服务的规律使用并改善疾病管理，实现了住院抵消效应，即通过上述改善减少住院。第二，这种抵消效应在保障方案未针对的慢性病中更为明显，提示存在较强的正向跨疾病溢出效应。第三，学习促进了对保障方案针对和未针对的疾病进行更高效的管理。我们的研究结果凸显了一种可行的基于价值的保险设计，尤其适用于资金有限的发展中国家。
Abstract
A key challenge in expanding public health insurance programs is how to deliver these programs cost-effectively with limited budget. This paper studies a value-based insurance design that introduced prescription drug coverage for two chronic diseases—hypertension and diabetes. This targeted drug coverage scheme increased the use of primary care and sharply reduced hospitalizations, leading to substantial net savings in total medical expenditure. Three operating channels were in play. First, a hospitalization offset was achieved by stimulating regular use of primary care and improving disease management. Second, the offset occurred more notably for nontargeted chronic diseases, suggesting a strong positive cross-disease spillover effect. Third, learning contributed to more efficient management of both targeted and nontargeted diseases. Our findings highlight a viable value-based insurance design, especially for developing countries with limited funding.