How Do Consumers Choose Health Plans?

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How Do Consumers Choose Health Plans?
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The Big Three

• Cost
• Quality of Doctors and Hospitals
• Freedom to Choose

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Cost

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

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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

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Freedom to Choose

• Own doctor in plan
• Self-referral, ease of referral
• Lots of alternatives

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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)

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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.

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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

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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

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Characteristics of consumersthat matter

• Income
• Tolerance for financial uncertainty
• Health care needs
• Ongoing relationships with providers(s)
• Tolerance for filing claims
• Tolerance for rules and plans management of care