1. How Do Consumers Choose Health Plans?

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

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

4. 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.

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

6. 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%)

7. 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.

8. 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

9. 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

10. 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