It's Health Care, But Not As We Know It.

The first non-partisan survey is out on Consumer Driven Health Plans. Jointly sponsored by The Commonwealth Fund and the Employee Benefit Research Institute, the data is clear: owners of CDHPs like them less than people with more traditional, or comprehensive health care plans.

It's easy to see why. CDHPs are suppposed to transfer some of the risk of health insurance on to the patient, er, consumer. Once the consumer is sick, they get to make a choice: "Am I sick enough to buy a doctor, or do I think I will get better by myself?"

This choice is based on making a financial investment in your own health, that is, would you pay money to get whatever malady you are suffering with fixed?

Of course you have no way of knowing what sorts of prices you're being faced with, not being a diagnostician or privy to the art and science of medicine. But even if you knew your diagnosis, one of the findings in this study was that the tools for making these sorts of decisions, called "cost and quality infomation," is simply not provided by most plans. Even if it were, the survey says that the customers of health plans are not really inclined to trust them.

And why should they? Last spring UHC cut 75% of its doctors from their plan in St. Louis, based on what the MDs were willing to accept as payment. The identified "quality" doctors were those accepting the cheapest rates.

So, let's say you decide need to see a doctor, you then get make another choice: which one? The way many plans are set up, you would pay different amounts for different doctors; significantly more if you go out of network. There has been quite a bit of discussion on the importance of these tools, and what sorts of data ought to be included. Successful CDHPs should have data on providers and costs readily available.

Funny - no one talks about outcomes. I guess that's not very important.

CDHCs change behavior exacly the way its advocates said they would: they make people more cost conscious consumers of medical care.

But this study also points out that the early critics were also right: out-of-pocket costs are higher, and more people either delay or forego care due to costs.

Insurance companies have been trying for years to get out of the insurance business and with the CDHP they almost have their wish. Most of the risk premium has now been transfered to the patient. Denial of payment will become a thing of the past, as patients deny their own care due to rising out of pocket costs. The twin demons of expensive technology and the aging demographic have become temporarily subdued.

There has been lots of talk lately about universal care and the growth of the uninsured population. (Actually, the numbers have remained fairly steady, attributed often to Medicaid picking up the check.) Employers are protesting that the high costs of health insurance are unsustainable. CDHPs and their cost shifts may release some of that pressure, allowing the dysfuntional employment benefit system to totter on a few more years, paying the middle men far more than they are worth, for services that add nothing to the common good of the nation.

Lin
CrossPosted at http://www.signalhealth.com/node/513