Expanding the Definition of Prevention

A white paper authored by the University of Michigan, Center for Value-Based Insurance Design, Harvard Medical School, and the University of Minnesota suggests that expanding the definition of prevention could be beneficial for patients suffering from chronic diseases. Including “evidence-based services that prevent chronic disease progression and related complications” would allow better coverage of their conditions and could be key in improving outcomes.

Currently, many Americans have high-deductible health plans, which feature lower premiums and higher deductibles. Patients must cover a certain amount of the costs themselves before the insurance company will step in.

There’s a provision, which states that primary preventive services can be covered before the deductible is reached. However, those with chronic diseases are considered to have an existing condition, and therefore are excluded from the provision. Services for treatment, such as monitoring glucose levels and blood pressure, won’t be covered by insurance plans.

Changing the definition will have several benefits:

  • Increased enrollment – with coverage of chronic conditions, more Americans will be encouraged to purchase high-deductible health plans
  • Cost reduction – patients will not have the burden of out-of-pocket costs for basic services and overall healthcare spending will be decrease
  • Better utilization – patients will be more likely to seek out medical care for their conditions when needed, with reassurance of affordable treatment

If the IRS agrees and expands the definition of prevention to include chronic diseases, many Americans will have better access to the care they require.

Author: Apoorva Anupindi

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