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All residents in Switzerland, for example, are mandated to procure health-insurance coverage for a federally specified benefit package.
The biggest problem with such efforts is measuring and enforcing the rules that establish who receives a specified benefit and who doesn't.
As I have explained in detail in several earlier posts, forcing upon private insurers a mandate of community rating and guaranteed issue will not work, unless accompanied by a mandate upon all citizens to have at least a minimally adequate health insurance policy with specified benefit coverage.
That's because cost-cutting employers have been abandoning traditional defined-benefit pension plans, which promised workers a specified benefit but put all the investment risk on the company to make good.
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Last year, national insurance contributions – which the government has to spend on specified benefits – raised £102bn.
National insurance contributions – which the government has to spend on specified benefits – raise about £100bn a year.
Insurers submit bids to Medicare each year, saying how much they expect to be paid to provide specified benefits.
In some years, the outside actuary found, Detroit poured into the pension fund more than twice the amount it would have had to contribute had it paid only the specified benefits.
And the state sets minimum wages, maximum work hours, and often some levels of specified benefits.
This paper describes a clear conceptual model, based on several sources of evidence, which helps to articulate the theoretical basis for how, why and under what circumstances telehealth could provide specified benefits for patients with chronic health conditions.
The interview participants generally struggled with specifying benefits for community members, with several participants explaining that they had never considered benefits for community members in their role as an REB member.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com