Gaps in healthcare coverage create wide variations in personal healthcare costs for insured, uninsured, and underinsured individuals.  These gaps create opportunities to offer solutions that change medical and financial behavior to promote a more favorable outcome.

There are several types of “gaps,” including: out-of-pocket costs in insurance coverage, elective procedures, absence of insurance, high-deductible and other consumer-defined plans. 

Insurance plans provide “gap” information, but often in hard-to-understand ways.  The underinsured and uninsured often don’t understand the implications of their “gaps.”

The value/cost equation is skewed for many individuals, who expect medical care to be paid by “someone else” and do not believe they should incur expense for it. 

People are not aware of behavioral or other changes that might reduce their personal “gap” costs.  They are often driven by short-term medical costs to act against their own long-term financial/medical interests, and the financial interests of the overall “system.”

• How can information about an individual’s “gaps” be more effectively communicated to them?
• Could new purchasing or risk mechanisms (formal or informal) reduce the “gap” problem without creating other negative effects?
• Are there other ways to structure “gaps” (e.g. besides copays and deductibles) that conform more with people’s perceptions of cost and value, thereby creating better behavior (i.e. behavior that results in more favorable individual/system outcomes?)
• What working models have successfully reduced the “gap” problem, and/or positively influenced individual gap-related behavior?  (e.g. Veterans Administration, disease management programs, other)?

• Insurance Contract Tenure (length of terms)
• Cafeteria-style benefit plans
• Insurance regulations (on value of product)
• Communication tools (Internet, kiosk, brochure, etc.)
• Collaborative constituencies (e.g. unions, churches, charitable groups, educational facilities, community centers, etc.)