By NextBestFitPhase 1: Enactment & build · Step 1.5
Define the benefit package & cost sharing
Months 0–12 · Congress (statutory categories); UHA Chief Medical Officer; HTA InstituteDiscuss this step
Write down exactly what UHP covers, what it excludes, and what patients pay at the point of care: nothing for covered services. Out-of-pocket spending falls from $556.6B to $197.3B; what remains is for excluded items.
Legal vehicle
Universal Health Act, Title III (benefits); HTA Institute coverage determinations for additions and removals.
Who does it
Congress (statutory categories); UHA Chief Medical Officer; HTA Institute
When
Months 0–12
Recurring, per year
+$349.6B
The benefit package drives the utilization effect (+$349.6B a year across all services) and the remaining out-of-pocket spending ($197.3B).
In this step
Tasks
7 tasks
Design choice & alternatives
3 decisions with alternatives
Costs & calculations
2 cost items, each with its calculation
Trade-offs
3 pros · 3 cons · 3 trade-offs
Risks
2 risks with mitigations
What changes in the system
14 existing laws, programs, or institutions changed
Other countries
7 comparisons
Cost items
Depends on
Nothing: this step can start first.
Steps that depend on this one
None.