Consumer-Directed Health Care: How Well Does It Work?

The past 30 years have seen a revolution in the way disability is addressed in American society. While that revolution has found expression in most social domains, health care has lagged behind. America's system of health care has traditionally maintained an institutional bias and typically insisted that services and care be directed by health care professionals, with few options for consumer direction or control. Recently, health policy shifts and practice changes have explored consumer-directed health care. For example, federal and state governments and advocates have combined over the past ten years to explore the use of consumer-directed home and community-based health care, long-term personal assistance services, and telemedicine and telerehabilitation. Most recently, the Olmstead Supreme Court decision has provoked a wave of institution-to-community planning among states that are responsible for ensuring that Medicaid recipients are provided health care in the most integrated setting appropriate, typically the individual's home and community.