Clinton’s Health Plan : Health Plan: A User’s Guide : CHOICES : The health care game

Will you be able choose between the three basic types of health plans allowed under President Clinton’s reform proposal.

Here’s a guide in the form of a game that illustrates the trade-offs in costs and treatments for different types of health plans.

OBJECT: To be first to reach Nirvana of Good Care. To get there, you must travel along a path representing one of the three types of health plans allowed under Clinton’s reform plan. You will encounter various medical ailments and treatments, discovering trade-offs involved with each decision.

Generally, you will either pay more or encounter greater inconveniences, such as longer commutes to the doctor’s office, delays in getting appointments or a long spell in the waiting room. In the game, these inconveniences are represented as loss of turns.

“Convenience Avenue,” representing a fee-for-service plan, has less delays but more expenses. Running out of money can slow your trip. “Low Cost Way,” representing a health maintenance organization, is less expensive but you could lose turns because of longer waits in getting care. “Flexibility Alley” is a hybrid plan that combines elements of fee-for-service and HMO plans.

In real life, determining which plan is right for you involves weighing the cost and convenience of each. This game simulates those trade-offs, based on the cost structure that is actually proposed under the Clinton plan. (For more information about what is covered under the Clinton plan, see the graphic on page 3 of this special section.)

PLAYERS: Two or more. One player should keep track of players’ money.

EQUIPMENT: One die. Markers for each player.

RULES: Each player starts with $4,000, representing the $3,000 per family annual limits on out-of-pocket expenses, plus money to pay premiums. (In reality under the Clinton plan, if you exceed the out-of-pocket limit, your health plan will pay for necessary services. But for purposes of this game, if you go broke, you must apply for a Clinton plan subsidy.)

* Each player starts at the Open Enrollment box and must choose one of the three paths representing a type of health plan. More than one player can choose the same path.

* Pay the premium for that path and roll the die, moving the number of spaces corresponding to your roll. Take turns rolling the dice until someone reaches Nirvana.

* If you go broke, you must apply for a subsidy and cannot advance until you pay fully. Mark your spot and jump to subsidy box.

NOTE: Because the Clinton proposal requires all plans to include coverage for the same treatments, and to monitor quality of care, this game assumes that care is identical in all plans. The game also assumes that elective treatments will cost roughly the same, regardless of plan, because you have to go outside of the plan to get them. It’s unknown whether these assumptions will prove true if the Clinton proposal is implemented.

Open Enrollment

“Convenience Avenue” represents a fee-for-service plan, in which you choose your own doctor. There’s little waiting, but it’s more expensive.

“Low Cost Way” represents a health maintenance organization that offers low premiums and low co-payments but may require more waiting.

“Flexibility Alley” represents a hybrid; you generally get care from a set group of doctors at a central location, but you can seek care elsewhere for an additional fee.

Review Board

For your next turn, roll the die. If you get 1-3, the board has ruled against you. Lose one turn. If you get a 4-6, board rules in your favor. Collect $200.

Start The Health Care Game with Fee-for-Service: Convenience Avenue

Pay premium: $1,000

Mole on left arm. Biopsy co-payment: $50.

Sally’s braces not covered. Pay $1,500.

Eye infection. Office visit and drugs co-payment: $25

Slipped disc. Surgeon rushes to your side. Pay $1,000.

Vaccinations. Free.

Uncle Fred’s acting strange. Good thing all health plans pay for some psychiatric care.

Congratulations: Prospective parent! Prenatal exams. Doctor fees covered. Hospital co-payment: $800.

Annual exam. No wait. Co-payment: $10

Dr. Quack botched your back operation. Go to medical review board.

Aunt Emma’s gone nuts. Good thing all health plans pay for shrinks.

Eye infection. Office visit and drugs co-payment: $25

Jimmy’s got a drug problem. Betty Ford Clinic co-payment: $400

Samantha’s eyeglasses Exam and lenses co-payment: $25.

Breast enhancement. Not covered. Pay $2,000 or lose a turn.

Chest pains. Roll. If you roll a 6, it’s a heart attack. Check into hospital. Co-payment: $3,000.

Pink slip: Pay $200 for 100% of premium until you get a new job.

Car accident. Minor injuries land you in emergency room. Co-payment: $100.

Cancer treatments. Co-payments for chemotherapy, drugs and exams: $2,500.

Coverage for cancer treatment stops.** Lose two turns or pay $2,000 to continue treatment on your own.

Doctor’s visit. Co-payment: $10.

Prosthetic leg considered “custom.” Insurance won’t pay. Pay $250 to buy it anyway, or lose a turn arguing about coverage or go to the medical review board.

You have reached the “Nirvana of Good Care”

*

Start The Health Care Game with HMO: Low Cost Way

Pay premium: $500

Congratulations: Prospective parent! Prenatal care covered. But lose a turn while you counsel hospital roommate about Lamaze.

Eye infection. Office visit: $10

Nose job. Cosmetic surgery isn’t covered. Pay $2,000 or lose a turn.

Slipped disc. No charge but surgeon has three-month waiting list. Lose two turns.

Health education classes are covered.

Annual exam. Appointment in five weeks. Office visit: $10. Lose one turn.

Prosthetic arm is too “customized” and isn’t covered. Pay $250 to buy it anyway, or lose one turn, or go to medical review board.

Dr. Rude botched your hip surgery. Go to the medical review board.

Jr.’s eyeglasses. Pay $10.

Billy’s got a drinking problem. Treatment: Free.

Bobbie’s braces aren’t covered. Pay $1,500.

Burnout. You quit your job. Pay $100 for 100% of premium until you work again.

Cancer treatments. Hospital is free. Pay $200 for 20 office visits.

Mole is growing, but primary care “gatekeeper” won’t let you see a dermatologist. Lose one turn.

Motorcycle fall. Minor injuries land you in a non-plan emergency room. Pay $250 for treatment, or lose one turn while you argue about coverage.

Doctor’s visit. Co-payment: $10.

Chest pains. Roll. If you roll a 6, it’s a heart attack. Check into hospital. Lose two turns.

Coverage for cancer treatment stops.** Lose two turns or pay $2,000 to continue treatment on your own.

Vaccination. Free but lose a turn while you wait.

You have reached the “Nirvana of Good Care”

Start The Health Care Game with Hybrid: Flexibility Alley

Pay premium: $600

Eye infection. Office visit and prescription: $15.

Slipped disc. Surgeon has three-month waiting list. Lose two turns or pay $1,000 for treatment outside plan.

Mole is growing, but primary care “gatekeeper” won’t let you see dermatologist. Lose one turn.

Vaccinations covered, but you wait. Lose one turn.

Appendectomy? Dr. Botchit thought you wanted vasectomy. Go to medical review board.

Little Suzie’s eyeglasses. Pay $10.

Congratulations: Prospective parent! Everything’s covered, including out-of-plan doctor. But pay $800 for private room or lose one turn for lost sleep caused by hospital roommates’ snoring.

Sarah’s abusing drugs. Co-payment at Betty Ford Center: $400.

Plan says your mechanical hand is too customized. Pay $250 to buy it anyway, or lose one turn while you argue, or go to medical review board.

You’re fired. Pay $150 for 100% of premium until you get a new job.

Annual exam. Doctor’s late. Office visit: $10. Lose one turn.

Flexibility Alley Health Insurance Co.: The alliance rates your plan: It’s top notch.

Cancer treatments. Hospital is free. Pay $200 for 20 office visits.

Experimental cardiac surgery not covered. Pay $2,000 or lose a turn.

Coverage for cancer treatment stops.** Lose two turns or pay $2,000.

Bad fall. Minor injuries land you in a non-plan emergency room. Co-payment: $100.

Junior’s braces not covered. Pay $1,500.

Chest pains. Roll. If you roll a 6, it’s a heart attack. Check into hospital. Lose two turns or pay $3,000 for treatment out of plan.

Dr. Best, your pediatrician, not in plan. Co-payment: $20

You have reached the “Nirvana of Good Care”

** After 60 days, treatment for terminal ailments will be evaluated for effectiveness. If the patient isn’t progressing, coverage for additional treatments can be cut off.