Monday, July 19, 2010

What choices will we have with health reform in the United States?

An article in Saturday's New York Times described how some larger insurance companies are trying to figure out how to market plans that will offer a choice of lower premiums to have restricted choice of providers.  A comparison is made with the old limited choice discussion of the 1990's and early and health maintenance organizations.This is an interesting end result of the health care reform legislation.  Much of the conversation from the President during the debate in 2009 was about not being denied choice.  At this point, it all depends on what we think of as choice.

The choice in this case will be to pay more to get more choice of providers.  For those who want to pay more the choices of providers will be there.  For those who don't want to pay--or who don't have the resources to pay--they may only have options of plans with limited choices of providers.  Insurers have indicated that they are not seeking only to limit providers but to assure quality among the limited choice.

Research on earlier managed care plans suggested that the plans were good at containing costs in the short run but the plans did not necessarily limit the growth in costs.  Thus, having plans like these become more prevalent may be enough to save money for a while but may not change the eventual trajectory of costs. 

Is this the type of choice that the public thought it was going to receive?  Is encouraging insurers to figure out quality on behalf of their enrollees a likely solution for high quality care for patients in the long-run?  Do insurers have an incentive to compete on quality or on cost or both?  Can consumers recognize quality in an insurance plan?  Quality of medical care?  Is having plans that will limit choice and choose quality providers a likely solution for encouraging the provision of care that is cost-effective in the long-run?  Would another plan to align incentives of insurers and providers be more effective at controlling costs, providing high quality care, and encouraging the use of cost-effective procedures?  From whose perspective should the care be cost-effective, anyway?

These questions are not nececssarily easy to answer, but the general public in the United States will experience the consequences of the incentives that have been set for insurers and consumers in the coming years as the health care reform plan is implemented.

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