The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
The Fund identifies and shares policy ideas and analysis to advance state health leadership, strong primary care, and sustainable health care costs.
Keep up with news and updates from the Milbank Memorial Fund. And read the latest blogs from our thought leaders, including Fund President Christopher F. Koller.
The Fund publishes The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to health policy leaders.
The Milbank Memorial Fund is is a foundation that works to improve population health and health equity.
September 2009 (Volume 87)
Quarterly Article
Brian Elbel
Mark Schlesinger
Nov 5, 2024
Oct 30, 2024
Oct 23, 2024
Back to The Milbank Quarterly
Context: American health policy is increasingly relying on consumerism to improve its performance. This article examines a neglected aspect of medical consumerism: the extent to which consumers respond to problems with their health plans. Methods: Using a telephone survey of five thousand consumers conducted in 2002, this article assesses how frequently consumers voice formal grievances or exit from their health plan in response to problems of differing severity. This article also examines the potential impact of this responsiveness on both individuals and the market. In addition, using cross-group comparisons of means and regressions, it looks at how the responses of “empowered” consumers compared with those who are “less empowered.” Findings: The vast majority of consumers do not formally voice their complaints or exit health plans, even in response to problems with significant consequences. “Empowered” consumers are only minimally more likely to formally voice and no more likely to leave their plan. Moreover, given the greater prevalence of trivial problems, consumers are much more likely to complain or leave their plans because of problems that are not severe. Greater empowerment does not alleviate this. Conclusions: While much of the attention on consumerism has focused on prospective choice, understanding how consumers respond to problems is equally, if not more, important. Relying on consumers’ responses as a means to protect individual consumers or influence the market for health plans is unlikely to be successful in its current form.
Author(s): Brian Elbel; Mark Schlesinger
Keywords: consumerism; responsive consumerism; health plans; voice; exit; markets
Read on Wiley Online Library
Read on JSTOR
Volume 87, Issue 3 (pages 633–682) DOI: 10.1111/j.1468-0009.2009.00574.x Published in 2009