How Do Consumers Choose Health Plans?

The “Big Three” Cost Quality of Doctors and Hospitals Freedom to Choose

Cost Covered services Deductibles, cost-sharing (80/20), copayments Cap on out-of-pocket expenses Premium contribution

Quality of Doctors (and Hospitals) Doctors and staff who communicate well with patients Getting help when you need it Convenient location “Technical quality” - harder to judge Story on NPR about article published in New England Journal-- Lower mortality rates in academic health centers. But patient surveys rated teaching hospitals lower. Because seemed less personal. Herds of people passing through.

Freedom to Choose Own doctor in plan Self-referral, ease of referral Lots of alternatives

Trusted sources of information Doctor (62%) Family and friends (58%) Employee benefits office (45%) Health plans (11-15%) Government (8%) Mass media (6%) Advertising (2%)

Different plans for different consumers For example, low cost or more choice?? Low-income take low cost over choice. Older people take choice over low cost. Importance of continuing with own doctor Older people have well-established relationships. Continuity important for ongoing health problems.

Scenario #1, Professor Long Married couple in mid-forties Two children (ages 9 and 11) Full professor who just moved to Penn State Everyone is healthy Most frequent contact with health system is for preventive care (Pap smear, mammogram, immunizations) Colleagues recommend Centre Medical and Surgical Associates

Characteristics of plans that matter Cost-sharing and financial risk Covered services (including preventive) Gatekeeper Access to specialists Access to providers outside network Whether current doctor and preferred hospitals in network Geographic service area Paperwork and claims

Characteristics of consumers that matter Income Tolerance for financial uncertainty Health care needs Ongoing relationships with providers(s) Tolerance for filing claims Tolerance for rules and plan’s management of care