The review process used by U.S. health care plans to evaluate new medical technology for coverage

Claudia Angelica Steiner, Neil R. Powe, Gerard F Anderson, Abhik Das

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To examine the process and information used by medical directors (MDs) of private health plans to make medical coverage determinations for new medical technologies, and to assess the influence of plan characteristics on the process. DESIGN: Cross-sectional national survey. PARTICIPANTS: Two hundred thirty-one MDs at private health plans representing 66% and 72% of the U.S. population covered by HMOs and indemnity plans, respectively. MEASUREMENTS: Actual and optimal review process, final decision authority, sources, and evidence used for technology coverage decisions. RESULTS: In 96% of plans, MDs take part in the medical policy review process for new technology. However, MDs have final authority over coverage decisions in only 27% of plans. Indemnity plans are more likely to assert that MDs should be responsible for final decisions, odds ratio (OR)=3.3 (95% confidence interval [95% CI] 1.4, 10). Optimal sources of information on new technology were journals, medical society statements or practice guidelines, and opinions of national experts. Actual sources of information used differed from optimal ones; local experts were used more often than is considered optimal (p

Original languageEnglish (US)
Pages (from-to)294-302
Number of pages9
JournalJournal of General Internal Medicine
Volume11
Issue number5
DOIs
StatePublished - May 1996

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Physician Executives
Technology
Delivery of Health Care
Insurance
Health Maintenance Organizations
Medical Societies
Health
Expert Testimony
Practice Guidelines
Cross-Sectional Studies
Odds Ratio
Confidence Intervals
Population

Keywords

  • evidence-based medicine
  • insurance
  • managed care
  • medical decision making
  • technology assessment

ASJC Scopus subject areas

  • Internal Medicine

Cite this

The review process used by U.S. health care plans to evaluate new medical technology for coverage. / Steiner, Claudia Angelica; Powe, Neil R.; Anderson, Gerard F; Das, Abhik.

In: Journal of General Internal Medicine, Vol. 11, No. 5, 05.1996, p. 294-302.

Research output: Contribution to journalArticle

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