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

Links

• 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:
  • Advance Medical
  • Best Doctors
  • ConsultingMD
  • WorldCare