Project on Insurer Decisionmaking Regarding Coverage of Medical Technologies

This project will examine how insurers and policy leaders make decisions about which technologies to cover and how these apply in practice. The study will examine four managed care organizations in various parts of the country, a state health commission on technology, and two non-network plans. The analysis will include empirical observation of decision making in these settings, ethical review of what constitutes "best practice," and the dissemination of findings. The project represents an opportunity to make a significant contribution to the national debate on access to specialized services. The project has four objectives. First, the project will develop a detailed analysis of the actual process, including the ethical reasoning employed, through which insurers make and implement decisions about the use of technologies. Second, it will provide conceptual and moral foundations for appropriate principles and features of process, including appropriate use of relevant methodologies such as cost-effectiveness analysis. Third, practical guidelines will be developed that will delineate a justifiable approach to decision-making about new and existing technologies for use by managed care plans, insurers and (potentially) state or national health boards. Fourth, the project leaders will work with existing associations of HMOs, insurers, state boards and legislative leaders to promote implementation of the guidelines.

Grant Details

Amount Awarded $188,661.00

Awarded on: 12/14/1995

Time frame: 1/1/1996 - 12/31/1998

Grant Number: 26732


Harvard Pilgrim Health Care Inc.

93 Worcester Street
Wellesley, 02148-3609


James E. Sabin
Project Director