Will insured citizens give up benefit coverage to include the uninsured?
OBJECTIVE
To describe the willingness of insured citizens to trade off their own health benefits to cover the uninsured.


METHODS
Descriptive study of individual and group decisions and decision making using quantitative and qualitative methods.


METHODS
Twenty-nine groups of citizens (N = 282) residing throughout Minnesota.


METHODS
Groups participated in Choosing Healthplans All Together (CHAT), a simulation exercise in which participants choose whether and how extensively to cover health services in a hypothetical health plan constrained by limited resources. We describe individual and group decisions, and group dialogue concerning whether to allocate 2% of their premium to cover uninsured children in Minnesota, or 4% of their premium to cover uninsured children and adults.


RESULTS
While discussing coverage for the uninsured, groups presented arguments about personal responsibility, community benefit, caring for the vulnerable, social impact, and perceptions of personal risk. All groups chose to insure children; 22 of 29 groups also insured adults. More individuals chose to cover the uninsured at the end of the exercise, after group deliberation, than before (66% vs 54%; P < .001). Individual selections differed from group selections more often for the uninsured category than any other. Nevertheless, 89% of participants were willing to abide by the health plan developed by their group.


CONCLUSIONS
In the context of tradeoffs with their own health insurance benefits, groups of Minnesotans presented value-based arguments about covering the uninsured. All 29 groups and two thirds of individuals chose to contribute a portion of their premium to insure all children and most groups chose also to insure uninsured adults.
Goold
Susan Dorr
SD
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor 48109-0429, USA. sgoold@umich.edu
Green
Stephen A
SA
Biddle
Andrea K
AK
Benavides
Ellen
E
Danis
Marion
M
D000328:Adult; D005260:Female; D006126:Group Processes; D018166:Health Care Reform; D006301:Health Services Needs and Demand; D006379:Helping Behavior; D006801:Humans; D007342:Insurance Benefits; D007348:Insurance, Health; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D008910:Minnesota; D012941:Social Responsibility