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Experience in the United States With Public Deliberation About Health Insurance Benefits Using the Small Group Decision Exercise, CHAT

Danis, Marion MD; Ginsburg, Marjorie MPH; Goold, Susan MD

Journal of Ambulatory Care Management: July-September 2010 - Volume 33 - Issue 3 - p 205–214
doi: 10.1097/JAC.0b013e3181e56340

“Choosing Healthplans All Together” (CHAT) is a small group decision exercise designed to give the public a voice in priority setting in the face of unsustainable health care costs. It has been used for research, policy, and teaching purposes. Departments of insurance in various states in the United States have used CHAT to determine public opinion about what should be included in basic health insurance packages for the uninsured. Some municipalities have used it to assess public priorities for direct service delivery to the uninsured. Setting up the exercise requires substantial preparation, but the public finds it simple to use and understand.

Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland (Dr Danis); Center for Healthcare Decisions, Rancho Cordova, California (Ms Ginsburg); and University of Michigan, Ann Arbor, (Dr Goold).

Correspondence: Marion Danis, MD, Department of Bioethics, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10, Room 1C118, Bethesda, MD 20892 (

Disclaimer: The views expressed here are those of the authors and do not necessarily reflect the policies of the National Institutes of Health or the US Department of Health and Human Services.

The authors thank all those who gave their time, effort, expertise, and financial resources to CHAT projects over the last decade. This effort was supported in part by the Intramural Research Program of the National Institutes of Health; the University of Michigan; several nonprofit foundations, including the Robert Wood Johnson Foundation, the Allina Foundation, the California HealthCare Foundation, the Kvar foundation, and the Houston Endowment; Departments of Insurance in several US states; and many businesses, particularly in Minnesota and California. The authors particularly thank the many participants in and organizers of CHAT exercises who gave their time anonymously.

© 2010 Lippincott Williams & Wilkins, Inc.