Assessing the Public Health Impact of State Health Benefit Mandates

Objective. To document the process used in assessing the public health impact of proposed health insurance benefit mandates in California as part of the California Health Benefits Review Program (CHBRP) to serve as a guide for other states interested in incorporating a public health impact analysis into their state mandated benefit review process.
Background. As of September 2004, of the 26 states that require reviews of mandated benefit legislation, 25 required an assessment of the cost impact, 12 required an assessment of the medical efficacy, and only 6 had language requiring an assessment of the public health impact.
Methodology. This paper presents the methodology used to calculate the overall public health impact of each mandate. This includes a discussion of data sources, required data elements, and the methods used to quantify the impact of a mandated health insurance benefit on: overall public health, on gender and racial disparities in health outcomes, on premature death, and on the economic loss associated with disease. In addition we identify the limitations of this type of analysis.
Conclusions. The approach that California has adopted to review proposed health benefit mandates represents a leap forward in its consideration of the impact of such mandates on the health of the population. the approach is unique in its specific requirements to address public health impacts as well as the attempt to quantify these impacts by the CHBRP team. The requirement to make available this information to the state government has the potential, ultimately, to increase the availability of health insurance products in California that will maximize public health.