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New Tools To Stem Rising Prices

New tools have emerged to keep rising health care spending in check. For instance, purchasers of health insurance and insurers themselves are establishing limits on how much they’ll pay for specific medical services and products.

The California Public Employees’ Retirement System — billed as the second-largest purchaser of health care services in the U.S. behind the federal government — more than three years ago set limits on how much it would pay for knee and hip replacements, some lab tests and some imaging services. More recently, CalPERS established caps for colonoscopies, cataract surgeries and some arthroscopic surgeries.

study published last month by the National Institute for Health Care Reform suggested the practice of setting limits — known as “reference pricing” — produced modest savings.

New limits on prescription drug benefits are also on the horizon. Beginning in January, as part of the Affordable Care Act, prescription drug spending will begin to count toward medical cost limits in insurance policies, meaning purchasers of policies with capped payments will reach the annual limit of what they have to pay sooner.

We asked stakeholders, researchers and consumer advocates if purchasers, insurers and policy makers are headed in the right direction by setting payment limits and adding drug spending to the overall medical limit on insurance policies. Should these kinds of limits be more widely applied or should other tools be used to stem rising health care spending?

We received response from:

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