CHAT

Name: “Choosing Healthplans All Together” (CHAT) is the name given to a game in which players decide which benefits they would like to include in their health insurance package.
Objective: This exercise is a simplified simulation of a complicated decision-making process involving much information and many trade-offs. The core goal of this method is to determine the health insurance benefit package that reflects the priorities of the group of players.
Method: CHAT is a decision-tool designed as a board game in which players use stickers to determine their choices of healthcare benefits within a pre-defined limited “sticker budget”. The CHAT board, designed like a pie chart, contains as many “slices” as there are benefit types to choose from. In the existing version, there are 10 benefit types (hospitalization, consultation, drugs, tests, indirect costs, preventive care, maternity, medical equipment, dental care and mental health care). Most benefits are offered at 2 different coverage levels (basic – which covers 50% of costs; and high – which covers 100% of costs).
The actuarial costs of each choice are reflected on the CHAT board in the number of stickers needed to “buy” the benefit. Participants can include benefits in their package until they run out of stickers. Selecting high coverage level is possible only when the basic is fully paid first.
The game is run in 2 rounds. In the first round, participants choose benefit packages that meet their and their families’ needs. In the second round, the entire group, composed of 12-15 individuals, needs to reach consensus on one benefit package for the entire group or the community. After the first round, the participants can validate their choices by checking how well they would be covered under different scenarios that are described in “health event cards” that each player pulls out in turn. So the 1st round of the game plus the validation with health event cards represent a mini-training session necessary to make the participants familiar with the game and understanding the objective before they can work as the group together.
Players are also asked to fill a short questionnaire before and after the game. The Pre-CHAT-questionnaire collects essential socio-demographic information, and the post-CHAT-questionnaire gathers attitudinal and satisfaction information.
The entire process is led by a facilitator that speaks the local language, who is helped by 2 or 3 assistant facilitators. The facilitator follows a script, which ensures that explanations and process are as standard and comparable as possible in different groups or locations.
Underlying principles: The game is client-centered in that it enables each to influence the composition of benefit package according to their perceived needs; and it is community-oriented in that all players reach consensus on the package, and pay the same premium for the risks they choose to cover (community-rating).
Evaluation: Based on the 1st pilot conducted in India in 2005, illiterate and innumerate people without prior experience with health insurance had no difficulty playing. Their choices reflected very judicious choices. Players and leaders reported high satisfaction with CHAT, and an improved insight into the perceived utility of community-based health insurance.
The short movie [download] offers a good impression about CHAT.