Ensuring Adequate Health Care Benefits for Children and Adolescents

A key element of any health care financing plan is the package of benefits which it covers. The nature of these benefits helps to determine both the value of a health plan to potential beneficiaries and the cost of that plan. Knowledge of the specific services included in a benefits package is not sufficient, however, to evaluate either the cost or the desirability of a health insurance program. Other key elements which help determine the cost and value of a program include the level of payments to health care providers and the degree of cost sharing required of beneficiaries. If the rates of reimbursement are too low, providers may be reluctant to service plan members for covered services. If the degree of cost sharing is substantial, enrollees may find purchase of covered services excessively burdensome. If cost sharing is low and provider reimbursement generous, the plan may become too expensive.