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Presented to the Citizens’ Health Care Working Group Washington, DC December 15, 2005

Draft Questions Sets for Community Meetings. Presented to the Citizens’ Health Care Working Group Washington, DC December 15, 2005 Jonathan Ortmans, PFI Hala Harika, AS. Discussion Topic: Benefits. Categorical eligibility (who is covered) versus universal coverage (what is covered):

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Presented to the Citizens’ Health Care Working Group Washington, DC December 15, 2005

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  1. Draft Questions Sets for Community Meetings Presented to the Citizens’ Health Care Working Group Washington, DC December 15, 2005 Jonathan Ortmans, PFI Hala Harika, AS

  2. Discussion Topic: Benefits • Categorical eligibility (who is covered) versus universal coverage (what is covered): Q: Do you want to have a system of care which is based on providing specific benefits to certain categories of people or do you want to have a system where specific benefits are covered for everyone? Sub-Question Examples: • What would you include in a basic benefit package? • End of Life Care -question to be developed • Long Term Care-question to be developed • Preventive Care-question to be developed

  3. Discussion Topic: Benefits 2. Incremental versus comprehensive reforms Q: Should we make comprehensive changes to provide coverage for everyone or should we make smaller changes to improve pieces of the system?

  4. Discussion Topic: Delivery • 1. Covering the Uninsured • Access to Insurance • 2. Expectations for Quality • Outcomes -question to be developed • Racial and ethnic disparities -question tbd • Efficiencies -question to be developed • Anti-waste measures; Mandates for health information technology; requirements for use of electronic technology as a condition of insurance payment

  5. Discussion Topic: Delivery 2. Expectations for Quality Q. What can be done to ensure people receive appropriate care? Sub Q. Do you favor the use of best practice treatment guidelines – commonly referred to as evidence-based medicine – to help reduce errors in treatment & improve quality? Sub Q. How effective do you feel Pay-for-Performance (P4P) initiatives will be in improving quality? And what might be some unintended consequences?

  6. Discussion Topic: Delivery 3. Tort Reform (relationship between performance and exposure to liability) -question to be developed 4. Underserved Areas Community health center; Community clinics; Free Clinics; Private sector Q. What can we do to shrink the disparity in care between urban/suburban and rural communities? Or wealthy vs. poor? Sub Q. What can we do to improve access to health information technology in rural/poor communities?

  7. Discussion Topic: Finance • Universal Coverage? • Q: Should there be an obligation for everyone to participate? (Catastrophic coverage at a minimum?) • Sub Question Examples: • An Individual Mandate? • An Employer Mandate? • Financed through Taxes? • Combination of Methods? • Q: What can be done to increase participation by employees who choose not to be insured?

  8. Discussion Topic: Finance 2. Financing: Relative Preference For: Q: Who should pay? Federal Government Federal Government/State Partnership Employer Household contributions Industry

  9. Discussion Topic: Finance 3. Financing: Q: How Should We Pay for Health Care Services? Sales tax on non-necessities Changes in exemption Premium changes Q: What factors should be used to determine premiums? Income testing Premium based on health status/usage

  10. Discussion Topic: Tradeoffs • 1. Tradeoffs between cost and choice • Q: Are you willing to pay more to have your choice of plans, doctors, or hospitals? • Example Sub-Questions: • Under what conditions would you pay more for choice? • How much more are you willing to pay to have your choice? • If you are willing to pay more, should it be out of pocket or through higher insurance premiums? • If you do not have choice over plans, doctors, or hospitals, under what conditions can you make appeals? What would be the administrative mechanism?

  11. Discussion Topic: Tradeoffs • 2. Navigating the system—variety of information/choice vs. simplicity of information • Q: How Do You Navigate the health care system to get the information you need? • Sub Question Examples: • What would help you navigate the system more effectively? • What level of detail from doctors and industry on conditions & treatments is most helpful

  12. Discussion Topic: Tradeoffs 3. Trade-off: overall quality vs. flexibility in treatment Q. Do you favor the use of best practice treatment guidelines – commonly referred to as evidence-based medicine – to help reduce overall errors in treatment & improve quality? Or do you feel that it will lead to “cookie-cutter” treatment?

  13. Additional Topics • Tradeoffs • Cost vs. Quality • Q: For what improvements in the quality of our system are you personally willing to pay more?

  14. Additional Topics • Tradeoffs • 3. Cost versus access • Q: Are you personally willing to pay more so that others can have access to health care? • Are you willing to pay higher taxes to provide all Americans with access to health care? • How much more in taxes or in insurance premiums are you willing to pay?

  15. Additional Topics Tradeoffs 4. Privacy versus improvements from electronic records 5. Spending more on health care at national level versus spending more on other priorities (e.g. education) 6. Would you be willing to pay more for health care now if it means your health care would be guaranteed in the future?

  16. Discussion Topic Criteria • Bold & Different • Well Suited for Community Meetings • Key Issues Without a lot of Existing Information • Issues that Influence Your Recommendations/Issues that Working Group Can Actually Influence • Questions: • Should Provide balanced perspective • Should Not Lead

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