Insurance benefit preferences of the low-income uninsured.
OBJECTIVE
A frequently cited obstacle to universal insurance is the lack of consensus about what benefits to offer in an affordable insurance package. This study was conducted to assess the feasibility of providing uninsured patients the opportunity to define their own benefit package within cost constraints.


METHODS
Structured group exercises.


METHODS
Community setting.


METHODS
Uninsured individuals recruited from clinical and community settings in central North Carolina.


METHODS
Insurance choices were measured using a simulation exercise, CHAT (Choosing Healthplans All Together). Participants designed managed care plans, individually and as groups, by selecting from 15 service categories having varied levels of restriction (e.g., formulary, copayments) within the constraints of a fixed monthly premium comparable to the typical per member/per month managed care premium paid by U.S. employers.


RESULTS
Two hundred thirty-four individuals who were predominantly male (70%), African American (55%), and socioeconomically disadvantaged (53% earned <$15,000 annually) participated in 22 groups and were able to design health benefit packages individually and in groups. All 22 groups chose to cover hospitalization, pharmacy, dental, and specialty care, and 21 groups chose primary care and mental health. Although individuals' choices differed from their groups' selections, 86% of participants were willing to abide by group choices.


CONCLUSIONS
Groups of low-income uninsured individuals are able to identify acceptable benefit packages that are comparable in cost but differ in benefit design from managed care contracts offered to many U.S. employees today.
Danis
Marion
M
Section on Ethics and Health Policy, Department of Clinical Bioethics, National Institutes of Health, Building 10, Rm. 1C118, Bethesda, MD 20892-1156, USA. mdanis@nih.gov
Biddle
Andrea K
AK
Dorr Goold
Susan
S
D000328:Adult; D015331:Cohort Studies; D003258:Consumer Behavior; D003362:Cost-Benefit Analysis; D005260:Female; D018166:Health Care Reform; D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D007342:Insurance Benefits; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000639:trends; D008484:Medicaid / Q000191:economics / Q000639:trends; D017057:Medically Uninsured; D008875:Middle Aged; D009657:North Carolina; D011050:Policy Making; D011203:Poverty; D011336:Probability; D012959:Socioeconomic Factors