Health Care Spending Guiding Principles

NPC established a set of principles to assess health care spending estimates and policies to ensure alignment with the goals of patient-centered care.

Health Care Spending Guiding Principles Cover

Purpose of Guiding Principles

These principles are intended to guide a rigorous, evidence-based evaluation and discussion of health care spending estimates and policies. They aim to improve health care spending efficiency and maximize patient health.

These principles can be used to (1) guide and evaluate health spending analyses’ methodological rigor, limitations and alignment with patient-centered care, and (2) guide and evaluate health spending policy, including identification of tradeoffs, risks of unintended consequences and implications for patient-centered care. Users can leverage the results of their analyses to inform policymakers, media and the general public.

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Why the Need for Guiding Principles

The continued rise in health care spending and patient out-of-pocket (OOP) costs in the United States has led to an intense debate among policymakers and other health care stakeholders on managing increasing costs. Numerous factors contribute to increased spending and OOP costs, including an aging population; structural, administrative and process complexity in the health system; innovative methods for disease prevention; improved speed and accuracy of diagnoses; adoption of novel treatments; health care prices and component costs; and benefit design.

Some of these factors also result in improved health outcomes and efficiency of care. However, constrained state and federal health care budgets indicate that the potential consequences of unchecked health care spending are real and significant. Such consequences include greater health disparities, lower budgets for other social services and general infrastructure, and erosion of consumer purchasing power. The relationships between health care spending and health outcomes are myriad and complex. Therefore, efforts to address rising health care spending must be balanced and based on evidence to avoid the unintended reversal of recent gains in health outcomes.

Development of Guiding Principles

NPC developed these principles in a multiple step process using established standards (e.g., all principles include citations). In the first step, NPC surveyed the relevant literature to develop a draft set of principles with supporting examples. These draft principles were reviewed in a blind fashion with external key policy opinion leaders, including academics, patient groups, payers (public and private), providers and think tanks. NPC incorporated feedback from these interviews into the final set of principles.

How to Use the Guiding Principles

These principles cover health care spending analyses, overall health care reform approaches and specific health care spending policies. They can be applied to federal, state, health plan or employer policies and supporting analyses above the individual service or treatment level. Health care spending analyses and policies vary substantially in objectives and scope, so not all guiding principles may apply to every instance.

The 18 guiding principles are divided into two categories:

Patient-Centered Guiding Principles for Evaluating Health Care Spending

These principles serve as a checklist to assess whether methods used for estimating health care spending are appropriate and aligned with the goals of patient-centered care.

Patient-Centered Guiding Principles for Reforming Health Care to Address Rising Health Care Spending.

These principles establish evidence-based standards for evaluating whether policy reforms address rising health care spending in a manner that improves patient health and system efficiency.

The purpose of each set of guiding principles and an example application are in Table 1.

  Patient-Centered Guiding Principles for Evaluating Health Care Spending Patient-Centered Guiding Principles for Reforming Health Care to Address Rising Health Care Spending
Purpose

(1) Examine the rigor and appropriateness of the methods used to estimate health care spending over time and across subpopulations.

(2) Ensure that health care spending analyses are evaluated in a manner consistent with the goal of patient-centered care.

(1) Establish patient-centered principles to guide and evaluate reforms designed to control rising U.S. health care spending.

(2) Evaluate individual health care spending policies for their intended and possible unintended impacts on patients’ health

Example application

(1) Review analyses (e.g., publications) to determine study quality and agreement with generally accepted methodological standards for analyzing health care spending.

(2) Review analyses to ensure consistency with patient-centered care.

(1) Evaluate legislative, regulatory and/or payer (public or private) health spending reform agendas to determine their alignment with building a patient-centered health care system in the U.S.

(2) Review legislative, regulatory and/or payer (public or private) health care spending policies or actions to determine their likely impacts on short-term and long-term patient health.

 

Health Care Spending Guiding Principles Infographic Cover

Guiding Principles Checklist

Download this infographic listing all the guiding principles for quick reference. 

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Health Care Spending Guiding Principles Case Study

A Case Study Using the Guiding Principles

NPC evaluated a study of drug pricing through the lens of its Health Care Spending Guiding Principles.

View the case study.