Consumer directed health care
Consumer-driven healthcare (CDHC), defined narrowly, refers to third-tier health insurance plans that allow members to use health savings accounts (HSAs), Health Reimbursement Accounts (HRAs), or similar medical payment products to pay routine healthcare expenses directly, but a high-deductible health plan protects them from catastrophic medical expenses. High-deductible policies cost less, but the user pays medical claims using a prefunded spending account, often with a special debit card provided by a bank or insurance plan.
If the balance on this account runs out, the user pays claims just like under a regular deductible. Users keep any unused balance or "rollover" at the end of the year to increase future balances>or to invest for future expenses. CDHC plans are subject to the provisions of the Affordable Care Act, which mandates that routine or health maintenance claims must be covered, with no cost-sharing (copays, co-insurance, or deductibles) to the patient.
This system is referred to as "consumer-driven healthcare" because claims are paid using a consumer-controlled account versus a fixed health insurance benefit. That gives patients greater control over their own health budgets. According to economist John C. Goodman, "In the consumer-driven model, consumers occupy the primary decision-making role regarding the healthcare they receive."
Goodman points to a McKinsey study which found that CDHC patients were twice as likely as patients in traditional plans to ask about cost and three times as likely to choose a less expensive treatment option, and chronic patients were 20% more likely to follow treatment regimes carefully.
Consumer-driven healthcare received a boost in 2003, with passage of federal legislation providing tax incentives to those who choose such plans. Proponents argue that most Americans will pay less in the long haul under CDHC not only because their monthly premiums will be lower but also because the use of HSAs and similar products increases free-market variables in the healthcare system, fostering competition, which, in turn, lowers prices and stimulates improvements in service.
Critics argue that it will cause consumers, particularly those less wealthy and educated, to avoid needed and appropriate healthcare because of the cost burden and the inability to make informed, appropriate choices. "Consumer-driven healthcare is badly named, because it's certainly not driven by consumers," said Jonathan Oberlander. It is "really just shifting the cost of healthcare onto the backs of the patients." People with chronic illnesses, such as diabetes, will be hurt, because with a deductible of $3000 to $4000, such people will never be able to save anything in their savings accounts. "Employers like it because they're going to save money," but they're not going to fund these healthcare accounts adequately, he said. "Conservatives tend to support consumer-driven healthcare. They believe, as do a fair number of health economists, that people use too much healthcare, and use too much healthcare of little value. If you move to high-deductible plans, people will think twice. If I have a sore throat, instead of going to my physician, I'll have a cup of tea instead."
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