Policy Options

Learn about policy options for changing the health system. What are the possibilities? What do we know about them? Click on one of the policy options listed below each category to jump directly to a discussion of that topic.

Change Insurance Coverage

Proposals in this category would change individuals' coverage status or level of coverage.

Individual Mandate A requirement that individuals have health insurance, either through an employer, an individual plan, a purchasing pool, or by enrolling in a public insurance program (such as Medicaid).	Refundable Tax Credit Tax code incentives aim to expand health insurance coverage by reducing the absolute cost that individuals face when buying insurance. When a tax credit is provided, individuals subtract the amount of the tax credit from their total tax liability. If the credit is refundable, people without a tax liability receive a direct payment.
Employer Mandate A requirement that all or some subset of employers offer health insurance to all or some subset of their employees. Proposals often include a "pay-or-play" provision - which means that employers may choose to offer health insurance to their employees (the "play" option) or pay a fee or tax into a public fund that is used to cover uninsured workers.	Medicaid/SCHIP Eligibility The primary purpose of expanding eligibility for Medicaid and/or the State Children's Health Insurance Program (SCHIP) is to increase the number of people who are eligible for these public programs, with a particular focus on individuals who do not have access to employer-sponsored insurance and who cannot afford to purchase private insurance policies.
Purchasing Pools Individuals or small groups assembled into a single entity for the purpose of purchasing health insurance. Purchasing pools often target uninsured workers whose employers do not offer health insurance or who are ineligible for benefits or cannot afford the premiums. The theory behind purchasing pools is to give small firms or individuals the same market power advantages that large firms enjoy when they purchase health insurance.	Open Access to Government Employee Program This policy option at the federal level would allow people who are not federal employees, their dependents, or retirees to participate in the Federal Employees Health Benefits Program (FEHBP). The FEHBP is the health insurance program offered to federal employees (including members of Congress), their families, and retirees. At the state level, this policy option would allow people who are not state employees, their dependents or retirees to participate in state employee health benefit programs. Those programs vary widely across the states in terms of their benefits and premiums.

Change Benefit Design

Proposals in this category would change the deductibles, co-payment, coinsurance amounts, the types of services covered, or the conditions of coverage.

High Deductible Health Plans

A fee-for-service insurance plan with a deductible that is larger than the deductible for more standard indemnity plans (in 2009 the federal standard is $1,150 per year or more for single coverage; $2,300 or more for families). Many such plans are accompanied by a savings option that allows people to set aside pretax dollars to be used to meet out-of-pocket health care expenses up to their deductible.

Change Payment Rules

Proposals in this category would change the way providers are paid for delivering health care services or serving a population.

Physician Pay for Performance

P4P uses financial incentives to stimulate improvements physician performance. P4P programs use a variety of performance measures, including clinical processes of care and health outcomes, patient experience with receiving care, and structural indicators such as health information technology investment. The financial incentives may take the form of an increased payment for each service delivered or a bonus.

Bundled Payment

Also known as "case rates" or "episode-based payment," a single payment for all services related to a specific treatment or condition (for example, coronary artery bypass graft surgery or CABG), possibly spanning multiple providers in multiple settings. Providers would assume financial risk for the cost of services for a particular treatment or condition as well as costs associated with preventable complications.

Hospital Pay for Performance

P4P uses financial incentives to stimulate improvements in hospital performance. P4P programs use a variety of performance measures, including clinical processes of care and health outcomes, resource use (i.e., efficiency), and structural indicators such as health information technology investment. The financial incentives may take the form of an increased payment for each service delivered or a bonus.

Comparative Effectiveness

Comparative effectiveness research examines the degree to which alternative treatments for the same health problem produce equivalent or different health outcomes. The products of comparative effectiveness research can be used in a variety of ways, including to provide information to physicians and patients in choosing appropriate treatments, as well as input into insurance benefit design, coverage determination, and payment.

Change Health Services Delivery

Proposals in this category are designed to facilitate or accelerate efforts to improve the delivery of health care services through better information, innovative models of care, or better infrastructure.

Health IT

Health IT refers to a variety of electronic tools for use in the management of health information, including the electronic medical record (EMR) and computerized physician order entry (CPOE). Policy options focus on approaches to accelerate adoption, including financial incentives, direct provision, regulatory mandates, development of standards, and enhancing the interoperability of health IT.

Disease Management

An organized, proactive approach to health care for members of a population with a specific disease or a combination of diseases - or care designed to prevent the development of specific diseases in those at risk. The aim of disease management is to increase the delivery of appropriate care to enrolled patients. Policy options focus on expanding the use of disease management in public and private insurance programs.

Change Legal Environment

Proposals in this area address various issues related to medical malpractice.

Medical Malpractice

When patients suffer harm as the result of negligent medical care, they are typically entitled to pursue compensation through the tort system. Policy options focus on reducing the number of claims or the average payout per claim by, for example, limiting the scope of available damages (as through non-economic damage caps), placing limits on attorney's fees, and imposing additional requirements for filing claims.

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