Insurance plans should strive for equity, not equality

Health insurance benefits form
Equitable insurance benefits, instead of equal benefits, may better serve patient needs. (Getty/michaelquirk)

As legislators debate the next steps of healthcare reform, expanding or paring back coverage options and adjusting plans is a hot-button issue. But as the conversation continues to unfold, the focus should be on achieving equity, not necessarily equality, experts say.

Equality in health insurance coverage doesn’t work the same way it would in other settings, like equal access to voting or equal consideration in hiring, wrote Betsy Q. Cliff and Michael Rozier, doctoral candidates in health management at the University of Michigan, and A. Mark Fendrick, M.D., a professor of internal medicine and health management at UM, in a blog post for Health Affairs.

Offering identical plans to everyone would offer larger packages than some people may need, and may not offer everything that other people need in their coverage.

“We should be designing insurance coverage in a way that provides access to care for people who need it, when they need it,” they wrote. “That requires a subtle but important shift from equal access to equitable access.”

RELATED: Study: Value-based insurance design program boosts preventive care

A value-based approach to insurance design can allow payers to stratify plans that offer services to the populations that need them the most. Value-based insurance design (VBID) can also be used to deter patients from seeking costly care that may have little to no clinical benefit for them, according to the blog.

VBID is already being applied in number of settings, including for Medicaid enrollees, but there are barriers to adoption, according to the blog. Designing insurance plans in a value-based model also tackles only the financial barriers to care, when there is a laundry list of other health inequities that can act as barriers to care access.

RELATED: CMS to expand Medicare Advantage value-based insurance design model

The Centers for Medicare & Medicaid Services is testing VBID in its Medicare Advantage plans. It first rolled value-based plans out in Arizona, Iowa, Indiana, Massachusetts, Oregon, Pennsylvania and Tennessee for 2017 enrollment, and will expand to Alabama, Michigan and Texas in 2018.