Tapping And Resolving Consumer Concerns About Health Care

Abstract:     
Consumer concerns about their health care have attracted intense attention as more Americans get care through prepaid managed care plans. A recent poll sponsored by the Kaiser Family Foundation reported that over half of Americans believe that managed care has decreased the quality of their health care. Journalistic reports and widely publicized court decisions involving coverage denials for gravely ill people have fueled consumer concerns as well. Consumer protection and access to high quality health care is an issue that resonates deeply with the American public, and reforms are in order.

Consumers have been heard in the political system. States have been active in legislating consumer protections into state HMO statutes, including stronger disclosure requirements and more open utilization review. President Clinton made consumer protection a cornerstone of his health policy agenda and convened a presidential commission that proposed recommendations for reform and a consumer bill of rights with respect to health plans. The 105th and 106th Congresses considered but did not pass patient protection legislation.

This article describes and analyzes the different systems for tapping and resolving consumer concerns and complaints about their health care. It presents a typology of consumer concerns, including how they are initially manifested and ultimately resolved. This article argues that the current legal systems for identifying and resolving consumer concerns are balkanized and incomprehensible to most consumers and inaccessible to many, particularly for those without health insurance. This article concludes with a suggested agenda for future research, and an outline of a theory for fair procedure to guide genuine reform.

JEL Classification: I0, I1

Accepted Paper Series