September 27, 2007
Disparities and Consumer-Directed Health Care
M. Gregg Bloche writing in Health Affairs: (subscription required)
First, I warn that adoption of the consumer-directed model as urged by its strongest advocates 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. Moreover, racial and ethnic disparities in care would probably worsen. Second, I contend that these worrisome 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 reducing deductibles and copayments 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.