From 1996 to 1998, Harvard Pilgrim Health Care examined how insurers, employers and other purchasers of health care decide which medical technologies to provide to consumers under resource constraints.
Under the grant, the investigators:
Conducted a detailed study of Harvard Pilgrim, including videotaping of decision-making committees and in-depth interviews with key figures.
Developed three case studies on technology decision-making in managed care organizations, including Kaiser Permanente of Northern California, Oregon Blue Cross Blue Shield and Aetna U.S. Healthcare.
Prepared a case study on the Oregon Health Resources Commission, a state agency chartered to review and assess medical technology.
The researchers presented these findings in articles in The Journal of the American Medical Association, New England Journal of Medicine, Health Affairs, the British Medical Journal and theHastings Center Report:
Managed care plans make decisions about providing new technologies by:
Managed care plans and other insurers face a "legitimacy" problem and need to persuade a skeptical public and practitioners that they should retain the authority to make limit-setting decisions about new technologies.
Managed care plans must show that their decisions regarding coverage for new technologies are publicly accessible, reasonable, open to appeal and regulated by an independent entity.