Evaluating Medical Effectiveness for the California Health Benefits Review Program

Abstract

An important aspect of the mandate assessments requested by the California legislature is a review of the scientific and medical literature on the medical effectiveness of the proposed health insurance benefit mandate. Although such a review bears many similarities to effectiveness reviews that might be undertaken for publication as research studies, several important differences arise from the requirements of the California legislation. Our reviews are intended to assist the legislators in deciding whether to support a specific mandate to modify health insurance benefits in a particular way. Thus, our assessments focus on how the scientific literature bears on the proposed mandate, which may involve a complicated chain of potential effects leading from altered coverage to ultimate impact on health. Evidence may be available for only some of the links in the chain. Furthermore, not all the evidence may be directly applicable to the diverse population of California or the subpopulation affected by the mandate. The mandate reviews, including the medical effectiveness analyses, may be used in a potentially contentious decision making setting. The legislative calendar requires that they need to be timely, yet they must be as valid, credible, and based on the best information available as possible. The focus on applicability also implies the need for informed, technical decisions concerning the relevance of the articles for the report, and these decisions need to be made as transparent as possible. These goals and constraints yield an approach that differs somewhat from an investigator‐initiated review of the literature.

An Analysis of California Assembly Bill 2185: Mandating Coverage of Pediatric Asthma Self‐Management Training and Education

“…At least two reviewers screened the title and abstract of each citation identified to determine eligibility for inclusion. Full‐text articles were obtained and reviewers reapplied the initial eligibility criteria (Luft et al 2006). …”

“…For those trials where outcomes were reported in natural units, weighted averages for each outcome measure were computed without confidence intervals. For outcomes where there was more than one trial, we estimated a weighted average percentage change, using the sample size for each trial and the estimated proportionate change expected in the experimental group (Luft et al 2006). …”

Translating Medical Effectiveness Research into Policy: Lessons from the California Health Benefits Review Program

“…CHBRP analyzes the possible effects of the proposed mandates on outcomes stipulated by the legislation or, if none are specified, the outcomes identified by qualified content experts as most important to evaluating the mandate's effectiveness. These findings are summarized in both text and tables (Luft et al 2006).…”

“…Here we focus on the lessons we have learned over the past six years from conducting medical effectiveness reviews for CHBRP. Our article builds on a series of papers published in 2006 that discuss the establishment of the program, the development of its analytic methods, and the first and second years of its operation (Halpin et al 2006; Kominski et al 2006; Luft et al 2006; McMenamin, Halpin, and Ganiats 2006; Oliver and Singer 2006; Philip 2006 ) . Over the ensuing years, the number of reports issued by CHBRP has grown from twenty‐two to fifty‐nine.…”

Health Services Research as a Source of Legislative Analysis and Input: The Role of the California Health Benefits Review Program

“…As the articles elsewhere in this issue demonstrate, the review of proposed health insurance mandates is a highly technocratic exercise (Halpin et al 2006; Kominski et al 2006; Luft et al 2006; McMenamin, Halpin, and Ganiats 2006). It is produced and debated within a small, specialized group of policy professionals occupying positions inside and outside of government, often referred to as an issue network or policy community (Heclo 1978; Walker 1981; Kingdon 1984; Whiteman 1987).…”