Cost-Effectiveness Analysis in the Context of US Commercial Health Insurance

Discussions of the cost effectiveness of medical services often are couched in the framework of a global budget constraint; for example, a national health insurance system that must balance government expenditures on healthcare services against other government spending priorities. The 'cost' part of the ICER (numerator) is positive, but the 'benefit' or health effect (denominator) is zero, and so the ICER, strictly speaking, is not defined, and medically useless care would be termed 'dominated'. [...]the elimination of medically ineffective care would produce savings with no loss of health, whereas the savings associated with eliminating coverage of cost-ineffective care would be accompanied by a possible decrement in health, even if the probability or magnitude of that loss was very small. What employees stand to gain from a reduction in medically ineffective or cost-ineffective care is lower health insurance premiums and possibly increased wages. [...]rather than framing the issue as one of rationing, a more productive approach might be to frame it in terms of consumer choice of coverage-what treatments would consumers prefer to have covered by their health insurance policies versus paid for out-of-pocket?