If California were to enact a mandate for insurance companies to cover certain services, how much would this cost? How would it affect public health? Would utilization change?
To answer these questions, the California legislature charged the California Health Benefits Review Program (CHBRP) to estimate the medical effectiveness, public health and cost implications of proposed health benefit mandates. A paper in Health Services Research discusses the methods used to evaluate these potential mandates. In particular, legislators want the following two questions answered:
- the present baseline coverage for the beneﬁt and baseline per unit costs, utilization, and total per-member, per-month (PMPM) health care expenditures, and
- projected changes in coverage, per-unit costs, utilization, and PMPM expenditures following the implementation of the mandate.
The data sources used to answer these questions include:
- California Health Interview Survey,
- the KFF/HRET California Employer Health Benefits Survey,
- Milliman Health Cost Guidelines, and
- AHRQ’s Healthcare Cost and Utilization Project.
These reviews estimate not only the short term impact of a mandate, but also the long term impact. For instance, if a certain mandate increased utilization in the short run, costs likely will rise. If the increased utilization improves patient health in the long run, however, costs may decrease over a longer time horizon due to decreased hospitalization rates.
- Gerald F. Kominski, Jay C. Ripps, Miriam J. Laugesen, Robert G. Cosway and Nadereh Pourat, “The California Cost and Coverage Model: Analyses of the Financial Impacts of Beneﬁt Mandates for the California Legislature” Health Services Research, 41(3):1027-1044.