Goold SD, Biddle AK, Klipp G, Danis M; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Susan Dorr Goold, MD, MHSA, MA, Assistant Professor of Internal Medicine, University of Michigan Medical School 3116 Taubman Center 1500 E. Medical Center Drive Ann Arbor, MI 48109-0376 Tel: 734-936-5222; Fax: 734-936-8944; E-mail: sgoold@umich.edu.
Research Objective: As purchasers search for ways to control costs, consumer and patient control of healthcare decisions is weakening, resulting in enormous public frustration. Efforts to include consumers in priority-setting and insurance decisions face significant obstacles of apathy, voluminous and complex information requirements, and emotional barriers to making tradeoffs between competing needs for limited resources. In a low-income population, we evaluated an innovative exercise designed to overcome these obstacles to consumer involvement.Study Design: CHAT (Choosing Healthplans All Together) is a group exercise designed to measure laypersons' preferences and values for health insurance features within the constraint of limited resources. Fifty pegs, each of which represent 2% of a typical health insurance premium, are distributed by subjects using a gameboard of insurance options that includes a wide range of options: degrees of care management, breadth of coverage, restrictions on access and choice, and inclusion/exclusion of some services. Repeated cycles of the game incorporate role-playing in order to foster an appreciation for the consequences of insurance choices as well as the perspectives of other group members. Pre-and post-game written questionnaires evaluated participants' experiences of the exercise. Population Studied: Predominantly low-income North Carolina residents without healthcare expertise were recruited from ambulatory care and community settings.Principal Findings: Data are analyzed for 78 persons in 6 groups to date. The sample had a mean age of 42.9 (range 19-66), and was poor (81.8% <15k income), with 79% men and 80% minorities. Health status was fair or poor in 28.6%, 28.2% reported a chronic/serious illness in the family, 21.8% reported a household member hospitalized in the past 6 months, and 70.3% had had a doctor visit in the past year.Study participants found CHAT enjoyable (85.7%), easy to understand (93.4%), easy to do (93.4 %), and informative (90.8%). The majority indicated that they had learned a lot from playing the game (64.5%) and were motivated to learn more about health insurance (71.8%). More than 85% of participants were willing to abide by the group's chosen healthplan. Conclusions: CHAT is an enjoyable, easily understood, informative and motivating process which relatively disadvantaged, low income groups of persons without healthcare expertise can use to design healthplans that are cost-conscious and acceptable to them.Implications for Policy, Delivery or Practice: CHAT holds promise as an educational exercise for improving informed choice of health insurance. As a policy exercise, it can be used to incorporate the preferences and values of consumers into health insurance allocation decisions.Primary Funding Source: The Robert Wood Johnson Foundation, Picker-Commonwealth Scholars Program, and National Institutes of Health Division of Clinical Bioethics.
Publication Types:
Keywords:
- Consumer Participation
- Health Services Needs and Demand
- Health Status
- Humans
- Income
- Insurance, Health
- Male
- North Carolina
- Poverty
- economics
- ethics
- hsrmtgs
Other ID:
UI: 102272517
From Meeting Abstracts