What is meant by "benefit design" in healthcare?

The term "benefit design" in healthcare refers to the specific structure of health insurance plans that determines which services are covered for insured individuals. This includes specifying what medical services are eligible for coverage, the extent of that coverage, any exclusions, and the cost-sharing components such as copayments, deductibles, and coinsurance.

These design elements are crucial because they influence access to care, the types of services patients utilize, and ultimately impact health outcomes. An effective benefit design can help ensure that individuals receive necessary care while also promoting cost-effectiveness for both the insurer and the insured.

In the context of health insurance, understanding benefit design is essential for both healthcare providers and patients, as it sets the expectations for what treatments and services will be financially supported by the insurance policy.