Sacramento Healthcare Decisions Releases Report on Role of Cost in Health Care System

The not-for-profit health policy group Sacramento Healthcare Decisions has released the final report in a 22-month study on the role that cost plays in health care treatment and coverage decisions, the Sacramento Bee reports. In the final part of the Visible Fairness project, which ended last month, the group makes several recommendations to raise awareness and address the "conflicting demands that make it so difficult to control health care costs." The report calls for the use of clinical, or best practice, guidelines to help doctors make treatment decisions based on "current scientific research." In addition, the report urges doctors to learn how to use "cost-effectiveness" in medical decisions and "how to explain those decisions" to patients. However, the group found that patients would not likely accept cost-effectiveness "as a reason for a health plan's denial of treatment." The report recommends that health plans inform patients about the process used to make coverage decisions. "We have never included consumers in the bigger decisions about how health care dollars are spent," Visible Fairness project Director Marge Ginsberg said, adding, "But the consumer also needs to understand how the system works, how insurance works, what the limitations are, why there are limits on what they cover" (Griffith, Sacramento Bee, 11/18). The Visible Fairness project also included a physician survey, discussions with consumers, a consumer phone survey and a "Balancing Act" forum for players in the health care system (Sacramento Healthcare Decisions Web site).

Walter Zelman, CEO of the California Association of Health Plans, said some health plans have used "consumer advisory groups" to help inform patients about coverage decisions, with "mixed results." He added that employers should offer employees at least two health plans -- a low-cost plan and a more expensive plan -- to "give consumers more control" over their health care. Peter Lee, president and CEO of Pacific Business Group on Health, added that the organization in 2003 plans to offer a "wholly different" health plan called the "Breakthrough Plan" that will offer patients "more choice and more responsibility." He said, "It's trying to engage the consumer in considering the financial implications of their choices. The health care system has done that abysmally up until now" (Sacramento Bee, 11/18).