Helping Medicare Beneficiaries Choose Health Insurance: The Illness Episode Approach

Sofaer, Shoshanna; Davidson, Bruce N.; Goodman, Raymond D.; Grier, Reed; Kenney, Erin; Monk, Nancy; Ross, Alex

doi:10.1093/geront/30.3.308

Cited by 8 publications

(10 citation statements)

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“…Sofaer et al (76,78) conducted a quasi-experimental evaluation of an innovative approach to provide people with Medicare information about the financial consequences of their health care coverage decisions. All participants were enrolled in a three-hour workshop covering the same topics but using different materials.…”

Section: How Stable Are Patient Definitions and Ratings Of Quality?mentioning

confidence: 99%

“…When all dimensions of care are combined, the national overall score is 72. Nationwide, hospitals are doing best on physical comfort (82), involving family and friends (76), and coordination of care [see also (76)]. They are doing worst on emotional support (65), transition to home (69), and providing information and education [see also (69)].…”

Section: Hospitalsmentioning

confidence: 99%

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Patient Perceptions of the Quality of Health Services

Sofaer

Firminger

2005

Annu. Rev. Public Health

465

405

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■ Abstract As calls are made for a more patient-centered health care system, it becomes critical to define and measure patient perceptions of health care quality and to understand more fully what drives those perceptions. This chapter identifies conceptual and methodological issues that make this task difficult, including the confusion between patient perceptions and patient satisfaction and the difficulty of determining whether systematic variations in patient perceptions should be attributed to differences in expectations or actual experiences. We propose a conceptual model to help unravel these knotty issues; review qualitative studies that report directly from patients on how they define quality; provide an overview of how health plans, hospitals, physicians, and health care in general are currently viewed by patients; assess whether and how patient health status and demographic characteristics relate to perceptions of health care quality; and identify where further, or more appropriately designed, research is needed.Our aim is to find out what patients want, need and experience in health care, not what professionals (however well-motivated) believe they need or get.Through the Patient's Eyes (23)

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Section: How Stable Are Patient Definitions and Ratings Of Quality?mentioning

confidence: 99%

Section: Hospitalsmentioning

confidence: 99%

Patient Perceptions of the Quality of Health Services

Sofaer

Firminger

2005

Annu. Rev. Public Health

465

405

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“…Actual health service use for a given health problem clearly varies somewhat by insurance plan (e.g., Manning et al 1987); however, it is unclear how to incorporate such behavioral responses into the cost presentation strategies appropriately. Sofaer and her colleagues implemented the illness episode material using the same assumption, justifying the utilization patterns they illustrated as clinically appropriate (Sofaer and Kenney 1989;Sofaer et al 1990). …”

Section: Decision-support Strategiesmentioning

confidence: 98%

“…Sturman, Boudreau, and Corcoran (1996) speculate on the potential consequences of giving consumers decision-support information about out-of-pocket costs. We identified two published approaches for presenting such information to consumers: the ''total cost'' strategy (Francis 1996) and the ''illness episode'' strategy (Sofaer and Kenney 1989;Sofaer et al 1990). Both strategies aim to provide participants with a basis for comparing the expected annual outof-pocket costs of different plans.…”

Section: Previous Studiesmentioning

confidence: 99%

Health Plan Choice and Information about Out-of-Pocket Costs: An Experimental Analysis

Schoenbaum

Spranca²,

Elliott³

et al. 2001

INQUIRY

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RAND, 1200 South Hayes St., Arlington, VA 22202-5050. Recent data suggest that 75% of workers in the United States are offered health insurance through their place of employment, and that more than half these workers are offered a choice of two or more insurance plans (McLaughlin 1999). Choosing a plan is obviously an important personal decision for consumers and their families. In addition, many health policy experts have argued that competition among health plans for subscribers may help contain rising health care costs and promote quality of care (e.g., Enthoven 1978;Dowd, Feldman, and Christianson 1996). Indeed, employers increasingly are demanding that employees take responsibility for their health insurance choices, for instance, by providing financial incentives to choose low-cost plans (Maxwell et al. 1998). Yet efficient competition requires not only that consumers are offered choices among competing plans, but also that they have the skills and information necessary for making informed choices (e.g., Dranove 1993; Scanlon, Chernew, and Lave 1997).To this end, considerable effort has been invested in providing consumers with information on health plan quality. Prominent efforts to collect and disseminate such data include the National Committee on Quality Asssurance's Health Plan Employer Data and Information Set (HEDIS), and the Consumer Assessment of Health Plan Satisfaction (CAHPS ) program sponsored by the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) (McGee et al. 1999). In addition, several states have published report cards that compare health plans on the results of member surveys or HEDIS measures, and the Federal Employees Health Benefits Program provides HEDIS and CAHPS information on participating health plans.In contrast, with a few notable exceptions, rela- Inquiry/Volume 38, Spring 200136 tively little attention has been paid to enhancing consumers' ability to understand the potential cost implications of choosing alternative health plans. Each year during open enrollment period, consumers generally receive tables for available plans that list plan characteristics such as premium, deductible, copayments, benefit limits, stop-loss provisions, and rules for out-of-network coverage. However, research confirms that consumers have difficulty integrating these and other health plan characteristics in a way that facilitates meaningful comparisons across plans (e.g., Gibbs, Sangl, and Burrus 1996; Lubalin and HarrisKojetin 1999). This, in turn, limits consumers' ability to assess health plan value (Mechanic 1989).In this paper, we present the results of a study to develop and test the effects of decision-support materials to inform consumers about expected health plan costs. Specifically, we identified two cost presentation strategies outlined in previous research, and we developed decision-support materials based on these two strategies. We then assessed the effects of the decision-support materials on plan choice in a lab experiment, in whi...

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“…Among the indicators, patient care ratings (i.e., survey data) were best understood while "undesirable event" records-based data (e.g., rates of pediatric asthma hospitalization) were least understood, followed by "desirable event" records-based data (e.g., pediatric immunization rates) McGee, Sofaer, and Kreling 1996). Earlier studies by Sofaer and her colleagues (Sofaer et al 1990;Sofaer, Kenney, and Davidson 1992) showed that comparative information on something as concrete and interpretable as the costs of illness episodes by plan type had little impact on Medicare beneficiaries' understanding of Medicare in general or on their own health plan type.…”

Section: Comparative Plan Informationmentioning

confidence: 99%

What Do Consumers Want and Need to Know in Making Health Care Choices?

Lubalin¹,

Harris-Kojetin²

1999

Med Care Res Rev

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This article assesses the presumption that consumer choice in health care is based on a rational weighing of alternatives--that information consumers about plan or provider performance, when coupled with information on cost plus service scope and limitation, 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.

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Helping Medicare Beneficiaries Choose Health Insurance: The Illness Episode Approach

Cited by 8 publications

References 0 publications

Patient Perceptions of the Quality of Health Services

Patient Perceptions of the Quality of Health Services

Health Plan Choice and Information about Out-of-Pocket Costs: An Experimental Analysis

What Do Consumers Want and Need to Know in Making Health Care Choices?

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