title: Consumer-directed health care and the disadvantaged.
abstract: Broad adoption of "consumer-directed health care" would probably widen socioeconomic disparities in care and redistribute wealth in "reverse Robin Hood" fashion, from the working poor and middle classes to the well-off. Racial and ethnic disparities in care would also probably worsen. These effects could be alleviated by adjustments to the consumer-directed paradigm. Possible fixes include more progressive tax subsidies, tiering of cost-sharing schemes to promote high-value care, and reduced cost sharing for the less well-off. These fixes, though, are unlikely to gain traction. If consumer-directed plans achieve market dominance, disparities in care by class and race will probably grow.
authors.affiliation: Georgetown University Law Center, Washington, DC, USA. bloche@law.georgetown.edu
authors.forename: M Gregg
authors.initials: MG
authors.lastname: Bloche
mesh_terms: D003258:Consumer Behavior / Q000191:economics*; D017047:Cost Sharing; D003362:Cost-Benefit Analysis; D018166:Health Care Reform / Q000331:legislation & jurisprudence* / Q000379:methods; D019981:Health Care Sector / Q000639:trends*; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence*; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D020402:Medical Savings Accounts / Q000191:economics* / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000331:legislation & jurisprudence*; D011639:Public Opinion; D013660:Taxes; D014481:United States; D035862:Vulnerable Populations / Q000331:legislation & jurisprudence*