Beyond Competition

The Normative Implications of Consumer-Driven Health Plans

The Federal Trade Commission and Department of Justice report Improving Health Care: A Dose of Competition (2004) recommends a number of market-based reforms to improve the quality of care and reduce the trend in health benefit spending. The authors argue some of the reforms proposed in this report may have an adverse effect on access to services for certain populations. In addition, they argue that important ethical issues arise when policies are introduced based on faith in markets rather than empirical evidence. The authors use the example of consumer-driven health plans (CDHPs) to illustrate the limitations of viewing health policy reform from the perspective of Improving Health Care. They analyze features of CDHPs in light of the principles and evidence contained in the report, as well as looking at the broader implications of CDHP implementation. The article concludes by emphasizing the need for an evidence-based approach to examining new ideas about how to make insurance more accessible for the underserved at the same time as constraining costs.