Consumer-directed health care and the disadvantaged

Health Affairs

Volumn 26, Issue 5, 2007, Pages 1315-1327

  Bloche, M Gregg ^a,b  

^a GEORGETOWN UNIVERSITY LAW CENTER   (United States)

^b BROOKINGS INSTITUTION   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CONSUMER; COST; COST BENEFIT ANALYSIS; ECONOMICS; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HUMAN; LEGAL ASPECT; METHODOLOGY; PATIENT; PUBLIC OPINION; REVIEW; TAX; UNITED STATES; UTILIZATION REVIEW; VULNERABLE POPULATION;

CONSUMER SATISFACTION; COST SHARING; COST-BENEFIT ANALYSIS; HEALTH CARE REFORM; HEALTH CARE SECTOR; HEALTH SERVICES ACCESSIBILITY; HEALTHCARE DISPARITIES; HUMANS; MEDICAL SAVINGS ACCOUNTS; MEDICALLY UNINSURED; PUBLIC OPINION; TAXES; UNITED STATES; VULNERABLE POPULATIONS;

EID: 35148877178     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.5.1315     Document Type: Review

References (50)

1. Economic Report of the President no. 4, January 2007, http://www.gpoaccess.gov/eop/2007/2007_erp.pdf (accessed 13 April 2007).
2. U.S. Department of Health and Human Services, National Healthcare Disparities Report, 2006 December 2006, http://www.ahrq.gov/qual/nhdr06/ nhdr06.htm (accessed 13 April 2007).
3. Extended endnotes, both source and explanatory material, are available online at http://content.healthaffairs.org/cgi/content/full/26/5/1315/DC1. They are numbered to correspond with the numbering in the text; see Note 3 online.
4. See Note 4 online; ibid.
5. See Note 5 online; ibid.
6. See Note 6 online; ibid.
7. Regarding widening of disparities, see Note 7a online; ibid. Regarding the rising number of uninsured Americans, see C. DeNavas-Walt, B.D. Proctor, and C.H. Lee, Income, Poverty, and Health Insurance Coverage in the United States: 2005, Current Population Reports: Consumer Income, August 2006, http://www.census.gov/prod/2006pubs/p60-231.pdf (accessed 13 April 2007). Regarding employer cost shifting, see Note 7b online, as in Note 3.
8. Regarding out-of-pocket payments as proportion of spending, see ibid.; and Note 7c online. Regarding employees' portion of premiums, see G. Claxton et al., Employer Health Benefits: 2006 Annual Survey, September 2006, http://www.kff.org/insurance/7527/upload/7527.pdf (accessed 13 April 2007).
9. See Note 9 online, as in Note 3.
10. M.B. Buntin et al., "Consumer-Directed Health Care: Early Evidence about Effects on Cost and Quality," Health Affairs 25 (2006): w516-w530 (published online 24 October 2006; 10.1377/hlthaff.25.w516);
11. and K. Davis, "Consumer-Directed Health Care: Will It Improve Health System Performance?" Health Services Research 39, no. 4, Part 2 (2004): 1219-1234.
12. Institute of Medicine, Coverage Matters: Insurance and Health Care (Washington: National Academies Press, 2001).
13. T. Miller, "Getting on the Soapbox: Views of an Innovator in Consumer-Directed Care," Health Affairs 25 (2006): w549-w551 (published online 24 October 2006; 10.1377/hlthaff.25.w549).
14. J.C. Goodman, "What Is Consumer-Directed Health Care?" Health Affairs 25 (2006): w540-w543 (published online 24 October 2006; 10.1377/hlthaff.25.w540).
15. Buntin et al., "Consumer-Directed Health Care."
16. J.P. Newhouse and the Insurance Experiment Group, Free for All? Lessons from the RAND Health Insurance Experiment (Cambridge, Mass.: Harvard University Press, 1994); and Note 15 online, as in Note 3.
17. Newhouse et al., Free for All?
18. Ibid.; and Note 17 online, as in Note 3.
19. See, for example, D.B. Mukamel et al., "Quality Report Cards, Selection of Cardiac Surgeons, and Racial Disparities: A Study of the Publication of the New York State Cardiac Surgery Reports," Inquiry 41, no. 4 (2005): 435-446.
20. This estimate is a ballpark figure, made uncertain by variation in the deductibles, out-of-pocket maxima, and terms (including annual contributions) of the health savings accounts examined. These studies, summarized in Buntin et al., "Consumer-Directed Health Care," are L. Ozanne, "How Will Medical Savings Accounts Affect Medical Spending?" Inquiry 33, no. 3 (1996): 225-236;
21. and E.B. Keeler et al., "Can Medical Savings Accounts for the Nonelderly Reduce Health Care Costs?" Journal of the American Medical Association 275, no. 21 (1996): 1666-1671.
22. California Gov. Arnold Schwarzenegger's proposal for statewide universal coverage is illustrative, as is the Massachusetts health reform plan. Governor Schwarzenegger would phase out subsidies entirely at 250 percent of the federal poverty level. See "Governor's Health Care Proposal," http://gov.ca.gov/pdf/press/Governors_HC_Proposal.pdf (accessed 24 June 2007). Massachusetts does so at 300 percent of poverty. See Kaiser Commission on Medicaid and the Uninsured, "Massachusetts Health Care Reform Plan: An Update," Key Facts, June 2007, http://www.kff.org/uninsured/upload/7494-02. pdf (accessed 30 June 2007).
23. See Note 21 online, as in Note 3.
24. See Note 22 online; ibid.
25. Katherine Baicker, Council of Economic Advisers, personal communication, summer 2006.
26. See Note 24 online, as in Note 3.
27. A.G. Wilhelm, Digital Nation: Toward an Inclusive Information Society (Cambridge, Mass.: MIT Press, 2004).
28. H. Tu and J.L. Hargraves, "Seeking Health Care Information: Most Consumers Still on the Sidelines," Issue Brief no. 61 (Washington: Center for Studying Health System Change, 2003); and Note 26 online, as in Note 3.
29. S.M. Asch et al., "Who Is at Greatest Risk for Receiving Poor-Quality Health Care?" New England Journal of Medicine 354, no. 11 (2006): 1147-1156.
30. J.J. Mongan, R.E. Mechanic, and T.H. Lee, "Transforming U.S. Health Care: Policy Challenges Affecting the Integration and Improvement of Care," Health Policy Issues and Options, December 2006, http://www.brookings.edu/ views/papers/20061215_mongan.pdf (accessed 12 July 2007).
31. Federal Reserve Board 2001 Survey of Consumer Finances; analysis by Seth Stephens-Davidowitz (doctoral candidate in economics at Harvard University); see Appendix Exhibit 1, online as in Note 3.
32. Ibid.
33. See Note 31 online, as in Note 3.
34. A.M. Epstein, "Health Care in America - Still Too Separate, Not Yet Equal," New England Journal of Medicine 351, no. 6 (2004): 603-605;
35. and P.B. Bach et al., "Primary Care Physicians Who Treat Blacks and Whites," New England Journal of Medicine 351, no. 6 (2004): 575-584.
36. A.I. Balsa et al., "Clinical Uncertainty and Healthcare Disparities," American Journal of Law and Medicine 29, nos. 2-3 (2003): 203-219.
37. B.D. Smedley, A.Y. Stith, and A.R. Nelson, eds., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health (Washington: National Academies Press, 2003).
38. See Note 35 online, as in Note 3.
39. Regarding benefit to higher-income Americans, see L. Burman et al., The President's Proposed Standard Deduction for Health Insurance: An Evaluation (Washington: Urban Institute and Brookings Institution, Tax Policy Center, 14 February 2007). Regarding burden, see Note 36 online, as in Note 3.
40. Baicker, personal communication.
41. See Note 38 online, as in Note 3.
42. See Note 39 online, as in Note 3.
43. M.E. Chernew, A.B. Rosen, and A.M. Fendrick, "Value-Based Insurance Design," Health Affairs 26, no. 2 (2007): w195-w203 (published online 30 January 2007; 10.1377/hlthaff.26.2.w195).
44. See Note 41 online, as in Note 3.
45. T. Brennan and L. Reisman, "Value-Based Insurance Design and the Next Generation of Consumer-Driven Health Care," Health Affairs 26, no. 2 (2007): w204-w207 (published online 30 January 2007; 10.1377/hlthaff.26.2. w204).
46. See Note 43 online, as in Note 3.
47. Buntin et al., "Consumer-Directed Health Care."
48. See Note 45 online, as in Note 3.
49. Davis, "Consumer-Directed Health Care."
50. See Note 47 online, as in Note 3.