Updated August 4 at 10:04am

Quality, clarity key to health-plan choice

One of the most important promises of the health-insurance exchange being developed by Rhode Island is its transparency. The idea is that businesses and consumers, empowered by a system to view health-insurance products that spell out costs and benefits in an easy-to-access online database, will be able to select a product that works for them on both fronts.

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PBN Editorial

Quality, clarity key to health-plan choice

Posted:

One of the most important promises of the health-insurance exchange being developed by Rhode Island is its transparency. The idea is that businesses and consumers, empowered by a system to view health-insurance products that spell out costs and benefits in an easy-to-access online database, will be able to select a product that works for them on both fronts.

Health care consumers in Massachusetts are already seeing something similar in the state’s HealthConnector, through which consumers, employers and brokers can compare offerings and choose the most appropriate plan. But now, a new product is offering something more, and it may be an approach to health insurance that we will see in Rhode Island as well.

Health insurers in the Bay State are offering plans that provide similar services at different costs depending on the health care provider. Choose from within a designated lower-cost provider and you pay less out of pocket than if you had chosen the more expensive tier.

For this approach to work, transparency must be full – meaning both the costs of certain services, but quality metrics as well. Without both, it will be possible to create a two-tiered system of health care, one expensive but top of the line in terms of care, the other more affordable, although of undetermined, if not lower, quality.

As insurers in Rhode Island look to create these kinds of products, it should be clear that this last scenario is not good enough. What we all need is high-quality health care at a lower cost. To accommodate that, it is imperative that both cost and quality are made crystal clear, so that consumers can make fully informed decisions about the health care provided. •

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