What are Reasons For Consumer Driven Health Care?

Avoid Inflated Benefit Costs and Insure More People
+ Argument: People covered by first-dollar insurance are insulated from the cost of care. In some respects, this is great. They have no risk and no worries. However, this is not good when it leads to inflated premiums and reduced take-home pay (or elimination of health benefits entirely) by financially-stressed employers. Managed care tried to address this, but caused restrictions for consumers and role conflict for providers. Consumer Driven Health Care avoids inflated premiums by engaging consumers in evaluation of the costs and benefits of health care services — particularly for small ticket items. For some people and their employers, reduced health benefits costs make the difference between having some health insurance and having no insurance at all.

– Counter Argument: People do not control all their health care. For example, they have little choice about emergency services and many chronic conditions. People delegate many health care decisions to their providers/physicians. There are limits to how much the expenses of chronic conditions can be managed. These plans are too complex for consumers. For these reasons, it is unrealistic to expect people to “control” or “manage” their health care with these new plans.

+ Response to Counter Argument: People make decisions about many complex products and services, such as buying a home, purchasing legal services, going to college, etc. Why assume that they cannot understand and be engaged in decision making about their health and health care? People may not control all their health care, but they select non-emergency providers and have some role in many services that they receive. Many health conditions and costs are related to lifestyle and behaviors that people can influence.

Increase Consumer Choice, Reward Quality and Restore Provider-Patient Relationship

+ Argument: Many providers and patients are frustrated with intrusion of managed care plans in the selection of providers by patients and the practice of medicine by providers. Consumer Driven Health Care can contain health care costs without the supply side constraints of managed care. CDHC can: give consumers more choice in provider and service selection; restore independence to the physician-patient relationship; allow price differentiation and greater rewards for patient satisfaction with provider quality. Flexibility in the choice of providers and use of different health care services by CDHC is especially useful for people who want to see certain specialists or use alternative therapies that are not covered by traditional health plans.

– Counter Argument: If employers with all their group-purchasing clout were not able to negotiate reasonable prices or get good quality information from health plans providers, then what hope is there for their employees acting as individuals?

+ Response to Counter Argument: Good CDHPs do not leave employees to fend for themselves without support concerning prices and quality information. These plans provide online support for provider selection, quality information and price negotiation.

Individual Incentives and Support for Health Improvement

+ Argument: The term HMO stands for “Health Maintenance Organization” and the best HMOs help consumers to maintain their health, not just contain costs. However, savings for improved health in an HMO do not go directly to the engaged individuals. When an individual improves their health, the savings are spread across everyone in the plan. When an individual harms their health (e.g. through smoking), the added costs are spread across everyone in the plan. Consumer Driven Health Plans are different. CDRPs give people an individual incentive to do things that improve their health and to avoid things that harm their health. Good CDHPs provide support systems to help people improve their health as well as save money.

– Counter Argument: There are many diseases and accidents over which individuals have no control. These plans penalize those who get sick through no fault of their own — the very people whom health insurance is supposed to help.

+ Response to Counter Argument: Everyone has the opportunity to do something to improve or to harm their health. Consumer Driven Health Care back up the health benefits from doing the right things with financial benefits as well. Also, one can address the issue of uncontrollable conditions by paying more into the accounts of people with chronic illness over which they have no control.