TAILIEUCHUNG - The Illusion of Coverage: How Health Insurance Fails People When They Get Sick

Locked into an eighty-year-old model that prescribes central planning for every aspect of the . health system, America’s system of delivering health care has lost sight of the important role that consumers play in controlling health system costs and quality. Real world experiments suggest that people who pay for their own care cut utiliza- tion by 10% to 30% with no discernable effect on health. Saving even 10% of Wisconsin’s 2002-2003 health care spending would have saved $260 million. But how did this happen? How did the Wisconsin health care consumer become a passive cog in a very expen- sive machine? Interestingly, the answer has. | THE ILLUSION OF COVERAGE How Health Insurance Fails People When They Get Sick By Carol Pryor Andrew Cohen Jeffrey Prottas 2007 by The Access Project The Access Project TAP has served as a resource center for local communities working to improve health and healthcare access since 1998. The mission of TAP is to strengthen community action promote social change and improve health especially for those who are most vulnerable. TAP conducts community action research in conjunction with local leaders to improve the quality of relevant information needed to change the health system. TAP s fiscal sponsor is Third Sector New England a non-profit with more than 40 years of experience in public and community health projects. TAP is affiliated with the Heller School for Social Policy and Management at Brandeis University. If you have any questions or would like to learn more about our work please contact us. The Access Project 89 South Street Suite 404 Boston MA 02111 617 654-9911 Fax 617 654-9922 Catherine M. Dunham . President Mark Rukavina MBA Executive Director This report is also available on The Access Project website. 2007 by The Access Project Table of Contents Executive Summary. 5 Findings. 5 Discussion and Recommendations .10 Prevalence of Medical Bill Problems Among the Insurance Policy Characteristics that Increase Groups At Consequences of Inadequate Medical Bill Problems Among the Insured are Likely to Methodology and Respondent Characteristics. 17 Respondent How Does Health Insurance Fail People .19 Three Common Insurance Characteristics that Leave People at Premiums Deductibles and Other Cost Caps On Uncovered Insurance Processes that Leave People at Confusing Policy Out-of-Network Procedural Insurance Disputes and Confusing .

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