This project aims to develop a web-based version of CHAT, a game designed to help ordinary people better understand health insurance and help health insurance policy makers better understand the health care wishes of ordinary people.

health insurance, health care resources, health benefits, decision making, computer mediation, Internet, web

1. Adapt the eCHAT Player and Planner programs for delivery on the Internet.
2. Develop an Administrator program allowing users to set up player accounts, create player groups, customize games, and view usage reports.

The CHAT exercise has been used with several populations. For a review of research participant populations, visit: http://www.bioethics.nih.gov/research/chat.shtml

This project entails converting the eCHAT (CD-ROM) version of the original board game CHAT into a web-based program with more Administrator functions as well as some usability improvements from eCHAT studies.

CHAT is game-like exercise designed to help people pick health insurance benefits. CHAT presents the challenge of a full array of possible health care options, but limited resources. The goal of the exercise is to help people better understand health insurance and become more involved in designing group health insurance plans. Throughout the exercise, tradeoffs have to be made between competing needs for limited resources.

For the web version of CHAT, participants go step-wise through "rounds" online. The exercise is done both as an individual effort as well as by team effort (similar to the original board game) as the exercise progresses.

• Round 1a (Individual): Participants are presented with a circular health care board divided into as many as 17 benefit areas, with up to 3 levels of coverage (basic, medium, high) for each benefit. They are given a specific number of "markers" to spend on their benefits, which allows them to choose a subset of the benefit options they most prefer. It is impossible to select all benefits at their highest level of coverage with the markers they are given. Participants have access to information about what each benefit and level coverage provides while making their decisions. This information helps them weigh various tradeoffs, such as more or less convenience, flexibility of services, and cost sharing, as they consider which benefit options and level of coverage to select.
• Round 1b (Individual): Once all the markers are spent, and participants' benefit choices are saved, they view randomly presented "health events" depicting potential illnesses and accidents that could befall them. These events explain the consequences of participants' coverage decisions. The format gets across the message that resources for healthcare are limited, and that difficult tradeoffs have consequences for patients.
• Round 2 (Team): Once individual health care decisions are made, participants move to a group event. Participants view a health care board that shows where there was consensus of coverage amongst all members of the team as well as where there were individual decisions that do not correspond with others' choices. To get to a health care board with full consensus, individuals can nominate changes for the group plan, giving reasons and comments. They are encouraged through the user interface to visit a "discussion board" space to share their thoughts and respond to others' thoughts.
• Round 3 (Team): Participants view a final consensus board based on Round 2 discussions and changes, and finalize a group plan.
• Round 4 (Individual): Participants return to their original individual health care board and create an individual health plan again, making potential changes from their first board based on influences of the team process.

Ultimately, CHAT aims to help design and select health care plans that reflect everyone's values and priorities.

People have significantly greater appreciation for the interdependence of resources and clinical decisions after playing the game, and the CHAT exercise has been evaluated favorably, by participants, as a way to influence tough health policy decisions.

Due to the large number of studies conducted with CHAT (board game, electronic version, and web version) with very diverse populations, we refer you to publications for information about specific study results.

Kantner L, Goold SD, Nowak M, Monroe-Gatrell L, Danis M. Web tool for health insurance design by small groups: Usability study. Proceedings of the SIGCHI Conference on Human factors in Computing Systems, 2006. <br><br>

Danis M, Ginsburg M, Goold SD. The Coverage Priorities of Disabled Adult Medi-Cal Beneficiaries. Journal of Health Care for the Poor and Underserved 2006;17:592-609. <br><br>

Danis M, Goold SD, Parise S, Ginsburg M. Enhancing employee capacity to prioritize health insurance benefits. Health Expectations 10 (3), 236–247, 2007.<br><br>

Danis M, Biddle AK, Dorr Goold S. Insurance Benefit Preferences of the Low-Income Uninsured. Journal of General Internal Medicine 2002;17(2):125-133. <br><br>

Danis M, Biddle AK, Goold SD. Enrollees Choose Priorities for Medicare. The Gerontologist. Feb. 2004; 44(1):58-67. <br><br>

Goold SD, Green SA, Biddle AK, Benavides E, Danis M. Will Insured Citizens Give Up Benefits to Include the Uninsured? Journal of General Internal Medicine Aug. 2004, 19(8):868.<br><br>

Keefe CW, Goold SD. Designing Health Plan Benefits: A Simulation Exercise Medical Education Nov 2004;38(11):1196.<br><br>

Goold SD, Biddle AK, Klipp G, Hall, C, Danis M. "Choosing Healthplans All Together" A Deliberative Exercise for Allocating Limited Health Care Resources. Journal of Health Politics Policy and Law 30(4), August 2005.<br><br>

Danis M, Benavides E, Nowak M, Goold SD. Development and Evaluation of a Computer Decision Exercise for Consumer Participation in Insurance Benefit Planning. The Forum for Family and Consumer Issues 10(2), October 2005.<br><br>

Ginsburg M, Goold SD, Parise C, Danis M. (De)constructing "Basic:" Citizens Define the Core Elements of Coverage. Health Affairs, 25(6):1648-55, November 14, 2006.