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Use of a risk message may be an effective way to present health plan report card information to consumers

Most health plan report cards that compare the performance of health plans emphasize the importance of plan choice as a way to obtain better quality of care. However, a new study suggests that consumers better understand and value health plan report cards that are brief and to the point and emphasize the risks rather than the benefits of plans. The study, which was supported by the Agency for Healthcare Research and Quality (HS09218, James Lubalin, principal investigator; Research Triangle Institute), focuses on Consumer Assessment of Health Plans (CAHPS®), the most widely used set of products for measuring and reporting consumers' ratings of their health plans.

CAHPS® was developed with support from AHRQ. Phase I products were launched in 1997 and have since been adapted by a number of public- and private-sector agencies and organizations.

In this study, the researchers randomly assigned 207 respondents to review a comparative booklet of health plans that varied on two dimensions: whether the plan choice in the comparative booklet was presented in terms of possible risks or possible gains and whether the booklet contained or excluded explanations on how to use the information. Examples of risk messages were, "You could be at risk for lower-quality care," and "Protect yourself from problems in health plans," while an example of a benefit message was "Get the best." Participants reviewed the booklets, completed the questionnaires, and reported their health plan decisions in a later questionnaire.

Consumers understood risk messages better than benefit or gain messages (91 vs. 84 percent). Also, those who received a risk message were more likely than those given a gain message to think that their plan choice made a difference in the quality of care they received (92 vs. 81 percent) and were more likely to respond correctly to questions about health plan features (93 vs. 86 percent). Added explanations had an unanticipated negative effect on comprehension.

Higher income participants receiving a risk message were willing to pay more in premiums ($62 vs. $46 a month), drive for a longer time to a doctor (36 vs. 27 minutes), and give up their regular doctor to obtain a plan rated higher in quality (85 vs. 50 percent) than those receiving a benefit message. Lower income participants may have felt that they had less latitude to make trade-offs involving time and money.

See "Increasing the impact of health plan report cards by addressing consumers' concerns," by Judith H. Hibbard, Ph.D., Lauren Harris-Kojetin, Ph.D., Paul Mullin, Ph.D., and others, in the September 2000 Health Affairs 19(5), pp. 138-143.

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