Interventions

Players may enact one or more options from the following list of national programs or policies.

Expand insurance coverage
Improve quality of care
Simplify insurance
Expand primary care supply
Improve primary care efficiency
Change reimbursement rates
Coordinate health care
Change the self-pay fraction for the insured
Enable healthier behaviors
Build safer environments
Create pathways to advantage
Strengthen civic muscle

All Intervention options [PDF-177KB]
All Intervention options (with detailed specifications) [PDF-204KB]

		Expand insurance coverage Increase the fraction of people with private or government-provided health insurance. You may expand coverage for the advantaged and/or the disadvantaged population. *Consequences* Greater coverage improves access to quality office care, but as a result increases spending on visits, procedures, and medications. It also puts more demand on limited supply of primary care providers (PCPs) and increases insurance administration expenses
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		Improve quality of care Enhance the degree to which physicians and hospitals enact best practices and make effective clinical decisions. You may improve the quality of preventive and chronic care, which includes screening to identify health concerns, as well as enhanced management of diseases, injuries, and asymptomatic disorders. Separately, you may improve the quality of urgent care for events that require emergency and perhaps intensive care. Consequences Better preventive and chronic care slows the progression of asymptomatic disorders into disease, and reduces the frequency of acute and urgent episodes. It also, however, increases spending on office visits and medications, and puts more demand on limited supply of PCPs. Better urgent care reduces the need for inpatient stays and reduces the fatality of urgent events. Quality urgent care also reduces the risk of disability and the subsequent need for extended care in nursing homes or home health care.
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		Simplify insurance Reduce the complexity of different health plans and the associated burden on the billing function of provider offices. This may be accomplished through standardization of health insurance plans (analogous to what some states have done with auto insurance) or through a single-payer approach. Single payer goes beyond standardization by reducing overhead costs for not only providers but also insurers. Consequences Standardized insurance and single payer both lower PCP billing costs and thereby improve PCP income. Single payer also reduces the marketing and negotiation associated with private insurance and thereby reduces insurance overhead costs.
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		Expand primary care supply Increase the number of new practicing primary care providers (PCPs) through incentives such as scholarships, subsidies, and/or guaranteed placement programs. You may offer these incentives for providers to the advantaged population, and/or for providers to the disadvantaged. Consequences The supply of PCPs is increased, but if this leads to a surplus, then average net income may decline.
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		Improve primary care efficiency Increase the fraction of primary care providers (PCPs) whose practices or clinics are streamlined to run as efficiently as possible. This is sometimes referred to as idealized design of clinical office practices (IDCOP). The IDCOP approach comprises a number of techniques for appointment scheduling, staff utilization, and use of information technology. Consequences Greater efficiency could alleviate a shortage of PCPs and increase PCP average net income.
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		Change reimbursement rates Amounts per visit paid by insurers to physicians or hospitals, expressed relative to their initial values (=1). The relative reimbursement rate for office visits affects payments for visits to primary care physicians and specialists. The relative reimbursement rate for hospital visits affects payments for hospital inpatient stays as well as visits to emergency and outpatient departments. You may modify these reimbursement rates up or down. Consequences Lowering reimbursement rates can reduce health care costs. However, it hurts the quality of preventive and chronic care and reduces PCP net income, which may lead to a decline in primary care supply. Similarly, lower reimbursement for hospital visits hurts the quality of urgent care and also may reduce elective hospital capacity, thereby impairing the effectiveness of disease and injury management in some cases
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		Coordinate health care Create coordinated, integrated systems of accountable health care that can reduce unnecessary office and hospital visits. Consequences The number of visits for people with disease and injury are reduced, with no adverse effect on health. This means fewer office visits for both PCPs and specialists (less referral and follow-up) and consequently fewer referrals for elective hospital procedures and inpatient stays. The effect is stronger for the advantaged than for the disadvantaged population, because the disadvantaged are already less likely to be referred to specialists for their care. Although this intervention does reduce provider incomes, it also alleviates some of their load, a fact which may help improve access somewhat for the disadvantaged population.
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		Change self-pay fraction for the insured Raise or lower the fraction of health care costs, including self-paid premiums and out-of-pocket expenses such as co-pays and deductibles, that is paid by those who have insurance coverage, sometimes known as the “cost sharing fraction.” Consequences Increased cost sharing reduces the affordability of quality preventive and chronic care and therefore its use.
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		Enable healthier behaviors Enable a greater fraction of people to engage in healthy behaviors, including not smoking, eating a healthful diet, being physically active, avoiding drug and alcohol abuse, engaging in safer sex, washing hands, refraining from violence, and others. You may enable healthier behaviors among the advantaged and/or the disadvantaged population. Consequences Healthier behaviors reduce the risk of disease or injury, and also reduce the risk of developing asymptomatic disorders (such as hypertension, high cholesterol, and pre-diabetes) that may subsequently lead to symptomatic disease.
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		Build safer environments Increase the fraction of people who live, work, travel, and play in places that are free from environmental hazards. You may build safer environments for the advantaged and/or the disadvantaged population. Consequences Safer environments reduce the risk of disease or injury. Outdoor safety also supports healthy behaviors such as physical activity.
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		Create pathways to advantage Increase the fraction of people who maintain a household income above $25,000 per year by assuring, for example, better education, job training, and/or living wage policies. Consequences Having moved from disadvantaged to advantaged, a person is less likely to experience stress-related disease, more likely to engage in healthy behaviors, more likely to live in a safe environment, and more likely to have health insurance and access to quality health care.
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		Strengthen civic muscle Increase people’s power to overcome resistance and enact chosen interventions. You may strengthen civic muscle in preparation for intervening more effectively elsewhere in the system. Consequences Greater civic muscle increases the extent or coverage of all interventions listed above aside from changes in reimbursement rates, gatekeeper requirement, and self-pay fractions.
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