A model for improving coverage policy decisions

Reasoned and defensible coverage decisions are essential for a fairer and m ore efficient healthcare system. Because healthcare resources are finite, c overage decisions should be informed by economic evaluations and made from a perspective that attends to the interests of both individuals and the pop ulation enrolled in a plan as a whole. Coverage decisions for all healthcar e interventions should follow a 2-step procedure that consists of (1) the r elatively impartial and objective assessment of an intervention's eligibili ty for coverage and (2) the distinctively value-laden determination (for wh ich the enrolled population's values and preferences should take priority) to cover, conditionally cover, or not cover an intervention.