Willingness of the insured to cover the uninsured
Journal of General Internal Medicine
August 2004
Will Insured Citizens Give Up Benefit Coverage to Include the Uninsured?
By Susan Dorr Goold, MD, MHSA, MA, Stephen A. Green, MD, MA, Andrea K.
Biddle, PhD, MPH, Ellen Benavides, MHA, Marion Danis, MD
OBJECTIVE: To describe the willingness of insured citizens to trade off their own health benefits to cover the uninsured.
DESIGN: Descriptive study of individual and group decisions and decision making using quantitative and qualitative methods.
SETTING AND PARTICIPANTS:Twenty-nine groups of citizens (N= 282) residing throughout Minnesota.
INTERVENTIONS: 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.
MEASUREMENTS AND MAIN 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.
CONCLUSION: 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.
http://www.blackwell-synergy.com/links/doi/10.1111/j.1525-1497.2004.32102.x
Comment: Two thirds of us believe in including everyone in the insurance risk pool, and nine tenths of us would be willing to abide by the health plan supported by the two thirds majority. Isn’t that strong enough support to move forward with a program of universal health care coverage?