Nearly 800 California residents were asked to design the best possible health plan for the uninsured, using a limited amount of dollars. The project used a game-like computer program called CHAT (Choosing Healthplans All Together) developed by University of Michigan and National Institutes of Health researchers.
Individually, and in small and large groups, the 798 participants picked from a range of options - including different coverage levels for preventive, chronic and last-hope care; different options for access to doctors; a variety of co-pays for appointments, hospital stays and ER visits; options for dental and vision care, different premium levels, and more.
In the end, the participants came to agreement on what to cover, what kinds of tradeoffs to make, and how much would be reasonable for participants to pay out of their own pockets. The result was a package that, for example, would pay for the least-expensive medicines first for chronic diseases like diabetes; give basic care for pregnancy, mental health, and rehabilitation; and cover only proven preventive tests and exams. But it wouldn't cover last-ditch catastrophic care, extraordinary end-of-life care, and conditions that interfere with quality of life but aren't seriously disabling.
The plan would cost two-thirds of the average cost for insurance plans in California. "They made many trade-offs to avoid saddling individuals with high co-pays and deductibles," says lead author Marge Ginsburg, executive director of SHD. "They also chose comprehensiveness of coverage over choice of doctor, and made a clear distinction between health care needs that are vital to basic living, and those that are less essential to productivity and longevity."
The CHAT game is designed so that individuals progress from designing a plan on their own, to working in small groups, and then to a larger group. A number of sessions lasting two and a half hours, and each involving 10 to 12 people, were held in 2005 and 2006. Half of participants were from Sacramento County. The participants varied in age, economic and educational background, and insurance status, though they were not fully representative of the California population.
Published in the November issue of the journal Health Affairs