Health Benefit Design

Why are some health treatments covered by insurance, while others are not? Why do some treatments have higher copays than others? These considerations are a result of how health benefits are designed.

There are many different approaches to health benefit design, but an overarching goal for most organizations is to realize the best value for their health care dollar while improving the quality of health care services and employee health. Among health care stakeholders, there is much debate about how to provide care with the right payment incentives, as well as about how to create incentives that reward quality and value rather than the volume of services provided.

In recent years, the National Pharmaceutical Council has undertaken research examining some of these issues around how health benefits are structured, including: