It seems to be a good idea to use targeted co-pays rather than a flat across-the-board approach, if you can target well. |
That requires knowing that there are good indicators of therapeutic effectiveness, having the administrative ability to use them in real time, being sure that patients or their doctors will not alter how they represent their illness to get lower co-pays, and being sure that, before the fact, consumers will accept insurance that will charge them more if they aren't that sick. |
There is a bit of evidence that a merger would bring economies of scale, but it's hard to say just who would benefit from those. |