Too often the public gets a bad rap for failing to understand that you can't always get what you want -- in health care. But a study released this past week by the Center for Healthcare Decisions reveals a much savvier understanding that there is a big difference being paying for surgery for a knee problem so someone can play soccer better and paying for it so someone can walk again.
The Center study was funded by the California HealthCare Foundation. They contracted with the Field Research Organization to survey 1000 people by telephone in California, asking them to rate the importance of insurance coverage for 55 different medical conditions in 87 different vignettes. In addition to the telephone survey, researchers held 15 focus groups in different regions of California,with different types of respondents, to dig more deeply into the tradeoffs.
The public was asked about a variety of medical conditions,with different levels of effectiveness and different outcomes. Here is an example:
A 50-year-old man has severe nerve pain in his shoulder following an accident. The
only medication for this type of pain is very expensive and often doesn't work
Then the interviewers asked:
1) On a scale of 1 to 10 (10 being highest), what priority
would you give to cover this if you were designing a
health plan for a general population in California?
2) Given that the more that health insurance covers, the
more the plan may cost you and others, would you
want health insurance to cover this service or not?
How would you predict people answered the two questions above? The first vignette received a higher priority rating than the second. And 90% of the respondents recommended coverage for the the first case, but only 75% for the second.
The only difference between these two vignettes is the effectiveness of the treatment. Clearly, the public understands that treatment effectiveness is a meaningful factor in coverage decisions. This should be a wake-up call to policymakers concerned about public reaction to wasting resources on ineffective care.
What Matters Most.
For the purpose of healthcare coverage, these are characteristics of medical situations
that matter the most to most people:
• Problems that are likely to lead to illness, disease, disability or death if not prevented or treated.
• Problems that interfere with functioning that is essential for the most important activities of daily living (work,
self-care, family care).
• Problems that may bring much higher societal costs if not treated early.
Among these high-priority situations, people support coverage when:
• Less expensive or non-medical ways of treating the problem have been tried first.
• There is medical treatment available that is proven to be effective.
What Matters Some.
Medical situations that some people also regard as important for coverage:
• Problems that cause physical discomfort but do not interfere with major activities of living.
• Problems that bring personal distress to the individual.
• Non-medical ervices that are designed to help individuals become or remain healthy and fit.
What Matters Least.
Medical situations that fewer people regard as important for coverage:
• Problems that are unsightly but not physically harmful.
• Problems that delay or prevent individuals from pursuing recreational activities.
• Treatments that are requested by patients for convenience or to feel reassured.
• Problems that are not medically significant or would resolve over time without treatment.
As national policymakers like Senators Kennedy and Baucus think about how to construct a benefit package that is comprehensive but cost effective for all Americans, they would do well to read the results of this research. This research demonstrates that the public absolutely can differentiate between what matters most and what matters least when it comes to spending our health care dollar.