Promote Efficient Use

  • Patient incentives
    • Cost sharing
    • Premium sharing
  • Utilization review
    • Prospective review
    • Concurrent review
  • Hospital utilization control
    • Ambulatory surgery
    • Second-opinion surgery
    • Hospital pre-admission limits
  • Pharmacy utilization control
    • Generic substitution
    • Drug formularies
    • Tiered pharmacy benefits
  • Cost-effective benefits
    • Convalescent care
    • Hospice
    • Birthing centers
    • Alcohol treatment
    • Mental health services
  • Worksite health clinics


  • Newhouse, J. P., and the Insurance Experiment Group, Free for All? Lessons from the RAND Health Insurance Experiment, Cambridge, Mass.: Harvard University Press, 1996.
  • Second-Opinion Surgery. Employers are increasingly using second opinion programs allowing independent specialists to remotely review cases and provide advice. Examples include:

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