Health Affairs, 24, no. 6 (2005): 1477 doi: 10.1377/hlthaff.24.6.1477 © 2005 by Project HOPE	New Online   House Health Reform Bill   Paying for Reform   Vetting AHIP's Report   HIV/AIDS Costs   Brief: Insurance Reform   HA Blog Top 10

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Consumerism

PROLOGUE

Consumerism And Managed Care

The following papers and Perspectives grew out of a roundtable discussion in April 2005 on "Health Care Market Competition: How Well Can It Work?" cosponsored by the Kaiser Permanente Institute for Health Policy, the Center for Studying Health System Change, and Health Affairs. The authors represent a wide range of viewpoints, but an important theme runs through the papers, which suggests a context in which the prospects for consumer-driven plans can be measured and perhaps liberated from the swirling rhetoric and hyperbole. This theme is ably introduced by James Robinson, under the ingenious rubric of "managed consumerism." Robinson hypothesizes that the market is already on its way toward assimilating many of the operational features of consumer-driven care within the framework of the prevailing insurance environment, which in turn represents an amalgam of managed care and indemnity coverage. A similar note is struck by Mark Hall and Clark Havighurst, who see health savings accounts as a tool for revitalizing managed care; Bryan Dowd suggests that managed and consumer-driven care are more likely to play complementary, hybridized roles in the market than to be mutually exclusive opposites.

Building on the extraordinary longitudinal research of the Community Tracking Study, Paul Ginsburg places the successive avatars of competitive theory and practice carefully in their recent historical context. Ginsburg, too, sees the increased focus on consumer incentives as complementing and refining, rather than substituting for, a hybrid insurance system that includes elements of both managed care and fee-for-service insurance. Finally, Mark Pauly argues that the most important factor behind rising health care costs is new technology, and that harnessing the power of competition to restrain costs might therefore best be achieved by structuring health plan competition around technology diffusion policies, so that consumers could choose to pay less for a plan that did not lavish expensive new technologies on its enrollees indiscriminately.

Perspectives by Robert Berenson, Jay Crosson, Robert Galvin, and Greg Scandlen round out this section, with Scandlen taking vigorous exception to the notion that consumer-directed plans could be assimilated by managed care.

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