Insuring Value, Not Loss: Nursing Care, Accreditation, and Care-Pathway Performance in the Pricing of Private Health Insurance in Europe.

Europe has entered a new era of health technology assessment. Clinical value is now appraised jointly across member states. Economic evaluation remains national. Cost-effectiveness, weighed in cost per quality-adjusted life year, is still decided country by country. Value is therefore appraised for what is used. It is not appraised for how well the care around it is delivered. Private health insurers face a parallel gap. The premiums they set rest largely on the characteristics of the insured and on claims history. They seldom reflect the quality of the care that members will actually receive. That quality is not intangible, as the evidence discussed here shows. Nurse staffing and nurse education are associated with hospital mortality. Structured clinical pathways are associated with fewer in-hospital complications and shorter stays. Accreditation is associated with a better safety culture and better organisational performance. The economic value of nursing has been quantified, where nurse-led care has been translated into savings and quality-adjusted life years. We therefore propose a heuristic model. Insurers would appraise these four elements periodically, in each contracted setting, and would let the result inform the premium. The aim is to reward the value that good nursing care creates. Today, the premium absorbs only the loss that poor care leaves behind. The model is a starting point. It would require actuarial modelling, piloting, and validation before use. It would also require safeguards against gaming and against penalising under-resourced providers.