1. The Internet publishes many examples of health “report cards.” For example, look at material on the website www.opa.ca.gov/Pages/Home.aspx, which was compiled by the State of California’s Office of the Patient Advocate. To what extent do you think consumers can use this information to make effective choices regarding health plans, hospitals, and medical groups? What sorts of individuals will be the most likely to be successful at making these choices?
2. With few exceptions, health insurance is mandatory for all Americans as a result of the Patient Protection and Affordable Care Act (PPACA or ACA). There are now various insurance products on the market that require large patient cost sharing. Most recently, deductibles have risen a great deal. (Interestingly, high deductibles are particularly prominent in the ACA’s healthcare exchanges. Silver plans have deductibles averaging over $2,000 a year, and Bronze plans $5,000.) The text presents recent evidence on these so-called Consumer-directed health plans and a list of concerns (below). Identify two concerns you would place at the top of the list and explain why you feel these are the greatest threats to the demand for healthcare List of concerns • Exposing consumers to higher out-of-pocket prices will discourage them from using services that may be beneficial to their health. Earlier, we noted a study by Greene and colleagues (2008), who found that those enrolled in a high-deductible CDHP often stopped filling prescriptions for high blood pressure and high cholesterol medications. • The information consumers need to make case-by-case decisions about what services to use is either not available or extremely difficult for all but the most expert to use. • CDHPs have a greater appeal to those who are in better health and who do not have chronic conditions, which leads to the potential for serious adverse selection and increases in premiums for those who do not join such plans. • Nearly every aspect of CDHPs has the potential to harm disadvantaged populations. These groups of people have lower incomes and therefore are less likely to be able to afford increased copayments. They are also less likely to be able to use what information is available, which is usually only on the Internet (Bloch 2007). Bloch (2007, 1322) calls this the “reverse Robin Hood” effect, with “redistribut[ion of] money from the less advantaged to the prosperous.” • Many studies have shown that CDHPs do not result in decreased expenditures, although there is a great deal of variability in the literature. Rather, expenditures are often just as high or higher because there are no cost-containment mechanisms in place once the deductible has been met.
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