Making Coverage Affordable and Aligning Financing to Health Outcomes

Lowering the overall cost of care is important for Californians to be able to have access to affordable coverage.

Goal Highlights

Lowering the Cost of Care Indicators

Access to coverage means early detection and longer lives

The uninsurance rate for the previous 12 months can be used to estimate the number of adults, adolescents, and children without health insurance coverage for the entire previous year.

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Americans are paying more out-of-pocket for health care now than they did in the past decade.

Most insurance plans require some form of out-of-pocket costs when patients receive a health care service covered by their plan. Out-of-pocket costs include copayments, coinsurance, and deductibles. These expenses are in addition to the amount a patient already spends on a monthly premium.

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Health spending in the US far exceeds that of other developed countries.

Lowering the cost of health care is critical for all Californians. Lower costs of care improve access to both affordable health insurance coverage and health care. Reducing overall cost of health care will also reduce costs to the State.

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Many Californians receive care in a fragmented system. (The Berkeley Forum)

Many Californians receive care in a fragmented system that does not emphasize coordination of care or take into account the higher costs of care received outside of the primary care setting.

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The way we pay for health care does not reward providers for improving performance (CHCF Health Care payment in transition: A California Perspective)

How we pay for coverage and care in the US does not provide incentives that reward value (improved quality and services at a lower cost). Instead, our system provides incentives for higher volume, often leading to over-use of services and high costs.
There is an urgent need for payment reform in order to better align costs with health outcomes. (CHCF Health Care payment in transition: A California Perspective)

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