Lauren D. Harris-Kojetin

What do consumers want and need to know in making health care choices

This article assesses the presumption that consumer choice in health care is based on a rational weighing of alternatives—that informing consumers about plan or provider performance, when coupled with information on cost plus service scope and limitations, will lead consumers to select high-quality, low-priced plans or providers. The authors review research on what health care consumers know, what they want to know, and what others think they should know. They also consider how people use information in making decisions and what this implies for what consumers really need to know to make effective decisions. The article concludes that assuming a rational consumer does not account for choice among options in the increasingly complex health care context facing consumers today. Based on this review, the article identifies gaps in the knowledge and sketches out a prospective research agenda in the area of consumer health care decision making.

Similarities and Differences in Choosing Health Plans

Background. Increasingly, consumers have multiple health insurance options. New information is being developed to help consumers with these choices. Objectives. To study similarities and differences in how the publicly and privately insured choose health plans. To explore the effect of traditional enrollment materials and reports developed by the Consumer Assessment of Health Plans Study (CAHPS) on consumers’ perceptions and decision-making. Research Design. Using data from eight CAHPS demonstrations, we tested for significant differences across consumers with employer-sponsored insurance, Medicaid, and Medicare. Subjects. Approximately 10,000 consumers with employer-sponsored, Medicaid, and Medicare health plans. Measures. Perceptions of the health plan selection process, use of information sources, and reactions to and use of traditional enrollment materials and CAHPS reports. Results. Most consumers with all types of insurance thought that choosing a health plan was important and obtained information from multiple sources. Choosing a plan was more difficult for Medicare and Medicaid recipients than for the privately insured. When choosing a plan, Medicaid recipients cared most about convenience and access, whereas the privately insured emphasized providers and costs. The percentage of consumers who looked at and remembered the CAHPS report varied widely from 24% to 77%. In all but one of the demonstration sites, most consumers spent less than 30 minutes looking at the CAHPS report. Conclusions. Group sponsors and the developers of information interventions such as CAHPS may need to invest in developing and testing different reporting approaches for Medicare, Medicaid, and privately insured consumers.

Do Content and Format Affect Older Consumers’ Use of Comparative Information in a Medicare Health Plan Choice? Results from a Controlled Experiment

We assessed the efficacy of materials that integrated comparative information on cost, benefits, and quality for employer-based retiree health plans and Medicare Advantage plans in a randomized experiment to test the impact of content and format. Results indicate that older consumers who received the intervention materials found the materials easier to use, gained greater knowledge about Medicare from them, were more likely to value comparative quality information, were more likely to select higher quality plans, and were more likely to choose a plan that reflected the dimensions they found most important compared to older consumers receiving the control materials.

Providing information to help Medicare beneficiaries choose a health plan

Abstract Many Medicare beneficiaries have limited knowledge of the Medicare program and related health insurance options. This is due in part to the complexity of the Medicare program and supplemental health insurance market. A recent congressional mandate through the Balanced Budget Act of 1997 called for broad dissemination of information to educate beneficiaries about their health plan options and to encourage informed health plan decision-making. In response, the Health Care Financing Administration (HCFA) launched the National Medicare Education Program (NMEP) to support the educational objectives of the BBA. This paper provides an overview of the components of the NMEP information campaign. We also review lessons learned from our experience in designing and testing a prototype consumer handbook that explains the different health plan options to Medicare beneficiaries. Through our discussion of the handbook, we highlight several ways to communicate information effectively about a complex publicly funded program to an older adult population.

The role of consumer satisfaction in ensuring quality long-term care: opportunities and challenges.

Abstract Consumer-satisfaction information can play a valuable role as one component among a broader set of publicly- and privately-led activities to improve the quality of long-term care (LTC). However, measuring and using consumer-satisfaction information in LTC is not without its challenges. We start by defining the ways in which we use the term “consumer satisfaction” in this article. We discuss current and planned uses of consumer-satisfaction information in assuring LTC quality. We end by describing some of the key opportunities for broader use of consumer-satisfaction information and accompanying challenges to be addressed to make more effective use of this information in the effort to improve LTC quality.

Private Sector Unlikely to Follow Medicare Lead in Providing Health Plan Disenrollment Comparisons

BACKGROUND There have been substantial efforts to improve the measurement and reporting of comparative quality information. A three-stage effort to develop comparative voluntary disenrollment measures for private health insurance plans is described. The literature on disenrollment and how key groups might use disenrollment information is reviewed; the development of a comparative survey of disenrollment is described; reasons employers, purchasing coalitions, and plans were ultimately unwilling or unable to sponsor the survey are delineated; and implications of these findings are discussed. DATA AND METHODS Methods used to develop the survey included review of existing literature on disenrollment, review of extant disenrollee surveys, cognitive testing, and expert review of the survey. Informal and formal interviews were conducted to assess the feasibility of different sponsors. RESULTS A disenrollment survey instrument that covered areas of common interest to consumers, purchasers, and plans could be developed, but sponsors to test the collection and reporting of these data could not be recruited. This was due to four interrelated factors: technical challenges in developing appropriate samples, wide variation in resources and capabilities of purchasers and plans, the perception that the costs of the survey outweighed the benefits of comparative information on disenrollment to the different sponsors, and the absence of strong demand from purchasers, regulators, or consumers to motivate plans to collect or report comparative information on disenrollment. IMPLICATIONS Several major barriers must be overcome before disenrollment information can become a component of comparative health care quality measures for the privately insured.