“The performance of consumer-driven health care has fallen short of both the aspirations of its proponents and the fears of its critics,” according to a review of the state of consumer-directed health care published in Health Affairs.

Jamie Robinson of UC-Berkeley and Paul Ginsburg of the Center for Studying Health System Change examine the first decade of consumer-driven health care (CDH). Early in the paper, the authors assert that there isn’t a Grand Unified Theory of CDH: it can be viewed through the various lenses of “philosophical advocates,” business entrepreneurs with profit motives, and policy change agents looking to incorporate high-deductible health plans (HDHPs) into the tax code.

After ten years of morphing, the authors say, what CDH looks like today doesn’t resemble its initial big vision.

Instead of CDH replacing managed care, it’s actually become a complement (or component) of it, Robinson and Ginsburg say.

Health Populi’s Hot Points: This paper is not a repudiation of consumer-driven health per se. The point is that consumers should be at the center and truly ‘drive’ their health choices.

However, Robinson and Ginsburg are right to point out that, “Health care is complex at best and not infrequently rife with nontransparent, anticompetitive, and even fraudulent behavior on the part of the many self-interested agents.”

For consumers to truly ‘drive’ health, they need transparency, tools, and meaningful options.

For now to the mid-term, the authors say, the market will continue to build hybrid forms that co-mingle managed care and CDH. They dub this type of model “managed consumerism” or “facilitated consumerism.”

With constrained resources in health, and consumers already paying large and growing shares of care out-of-pocket in this recessionary period, the question remains just how meaningful health plans can made their offerings so people engage in healthy behaviors and preventive efforts. For now, “managed consumerism” needs more constructive, proven approaches on the “management” side to bolster better outcomes for enrollees.