Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Want fair and affordable health insurance for the uninsured? Ask the public to design it

15.11.2006
Grassroots approach using health plan 'game' leads to equitable decisions about minimum insurance package, at lower-than-average cost

From Massachusetts to Hawaii, many states, counties and cities are working on ways to provide new health insurance options to the 45 million Americans who lack health coverage.

But the devil's in the details: Which treatments and preventive measures will the new plans cover? How much will they charge for doctor's visits and trips to the emergency room? Which doctors and hospitals will accept them? How much will they cost?

A new study published in the November issue of the journal Health Affairs reveals a promising way to deal with this thorny problem: Let the public decide.

In fact, the study suggests, grassroots decisions about what's fair, and what's affordable, may lead to coverage that will be acceptable to participants even though they are less costly than average health plans.

The study involved nearly 800 California residents from diverse backgrounds who took part in a project that asked them to design the best possible health plan for the uninsured, using a limited amount of dollars. The project, funded by the California HealthCare Foundation and organized by the nonprofit Sacramento Healthcare Decisions, used a game-like computer program called CHAT (Choosing Healthplans All Together) developed by University of Michigan and National Institutes of Health researchers.

Individually, and in small and large groups, the 798 participants picked from a range of options – including different coverage levels for preventive, chronic and last-hope care; different options for access to doctors; a variety of co-pays for appointments, hospital stays and ER visits; options for dental and vision care, different premium levels, and more.

Each of the options "cost" them a certain number of points, which were calculated based on actuarial estimates of the real-world costs of those coverage options. Just like in the real world, the amount of points (dollars) available to spend was limited.

In the end, the participants came to agreement on what to cover, what kinds of tradeoffs to make, and how much would be reasonable for participants to pay out of their own pockets. The result was a package that, for example, would pay for the least-expensive medicines first for chronic diseases like diabetes; give basic care for pregnancy, mental health, and rehabilitation; and cover only proven preventive tests and exams. But it wouldn't cover last-ditch catastrophic care, extraordinary end-of-life care, and conditions that interfere with quality of life but aren't seriously disabling.

In all, the authors calculate, the plan would cost two-thirds of the average cost for insurance plans in California. But still, the study participants didn't elect to make participants pay the maximum out-of-pocket costs.

"They made many trade-offs to avoid saddling individuals with high co-pays and deductibles," says lead author Marge Ginsburg, executive director of SHD. "They also chose comprehensiveness of coverage over choice of doctor, and made a clear distinction between health care needs that are vital to basic living, and those that are less essential to productivity and longevity."

Ginsburg's organization conducted the project, called Just Coverage, to solicit public input on the elements of basic health insurance coverage – in other words, if everyone had health insurance, what would be the minimum they would need?

The CHAT game is designed so that individuals progress from designing a plan on their own, to working in small groups, and then to a larger group. A number of sessions lasting two and a half hours, and each involving 10 to 12 people, were held in 2005 and 2006. Half of participants were from Sacramento County. The participants varied in age, economic and educational background, and insurance status, though they were not fully representative of the California population.

Although the researchers report the general consensus achieved by most participants, there were some major differences in the insurance choices made by people of different backgrounds. For instance, people with lower incomes and lower levels of education were more likely to include a category of coverage called "quality of life care" which included coverage for infertility, impotence coverage, and coverage for injuries that only affected athletic performance, not daily ability to function. The authors note that more research needs to be done on this kind of difference in viewpoints about the "necessity" of coverage for this kind of care.

Another aspect of the findings is that people seemed largely willing to forego coverage for "last hope" long-shot types of treatment. However, this kind of limit would represent a major change, because doctors and patients currently have a lot of discretion in choosing such options.

"We anticipate that by making basic coverage more affordable, it will be more possible to expand coverage to the uninsured." says co-author Marion Danis, co-inventor of CHAT and head of the Section on Health Ethics and Policy at the National Institutes of Health.

"When the public participates in designing basic benefit plans for the uninsured, they make well-reasoned tradeoffs," says co-author Susan Dorr Goold, M.D., MHSA, MA, an associate professor of internal medicine and health management and policy, director of the Bioethics Program at the U-M Medical School and co-inventor of CHAT. "This kind of participation may be key to developing plans that prospective participants will choose and will accept, especially when coverage is mandated as in Massachusetts' recently enacted health reform. A publicly-designed plan that limits coverage may be more acceptable to them than one designed from the top down."

The Massachusetts reform will require all state residents to have health insurance, and will offer a variety of public and private plans and subsidies depending on age, health status and income. The individual mandate is subject to the availability of affordable, credible coverage, but the details of affordability and what counts as credible coverage have not yet been decided.

In fact, Goold and a graduate student, Nancy Baum, address that very issue in a new essay in the Hastings Center Report, a leading medical ethics journal. The essay examines the potential impact on individuals depending on how "affordable" is defined -- and how insurance premiums, deductibles and co-pays are set -- by the Massachusetts board called the Connector. Although the Connector board includes representatives from "stakeholder" groups, it may benefit from seeking further public input into the plans it designs before finalizing them, the authors say.

Kara Gavin | EurekAlert!
Further information:
http://www.umich.edu

More articles from Studies and Analyses:

nachricht Multi-year study finds 'hotspots' of ammonia over world's major agricultural areas
17.03.2017 | University of Maryland

nachricht Diabetes Drug May Improve Bone Fat-induced Defects of Fracture Healing
17.03.2017 | Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

Im Focus: Researchers Imitate Molecular Crowding in Cells

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

Argon is not the 'dope' for metallic hydrogen

24.03.2017 | Materials Sciences

Astronomers find unexpected, dust-obscured star formation in distant galaxy

24.03.2017 | Physics and Astronomy

Gravitational wave kicks monster black hole out of galactic core

24.03.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>