Consumer-driven health plans not so alluring
Enrollment almost unchanged from 2005
Americans are not signing up for consumer-driven health plans (CDHP) that offer reduced premiums with higher deductibles of $1,000 or more for employee-only coverage and $2,000 or more for family coverage, according to a recent survey by the Employee Benefit Research Institute (EBRI) and The Commonwealth Fund.
Despite expectations from some policy makers that the lower premiums and tax benefits would encourage participation, the survey reveals that the uninsured are not signing up for the plans. Those who do participate in the plans, however, show more cost-conscious behavior in their health care decision making than individuals with more comprehensive health insurance.
Another survey, conducted by the Kaiser Family Foundation of enrollees in CDHPs, found that those individuals appear more likely to ask their physicians and other health care providers about costs than those in more traditional employer-sponsored health plans.
Relatively few of those enrolled in CDHPs, however, say they have used their plan's web site to compare price (5%) or quality (7%) across health care providers, about the same rates reported by those in traditional health plans, according to the Kaiser survey results.
The federal government has been highlighting CDHPs as a way to make patients more price-sensitive. Their existence also has been expected to put pressure on the health care industry to be more price-competitive and could mean greater responsibilities for access staff, since more patients will need financial assistance before receiving hospital services.
The EBRI/Commonwealth Fund Consumerism in Health Care Survey for 2006, its second year, was conducted to provide national data on the growth of CDHPs and high-deductible health plans (HDHP) and their impact on the behavior and attitudes of health care consumers.
The on-line survey of 3,158 privately insured adults ages 21-64 resulted in the following findings:
- Enrollment in CDHPs and HDHPs is virtually unchanged from 2005. Only 1% of privately insured individuals ages 21-64 are enrolled in CDHPs, representing 1.3 million people in that age group. Another 7%, representing 8.5 million people ages 21-64, were enrolled in plans with deductibles high enough to meet the threshold that would qualify to make tax-preferred contributions to a health savings account, but do not have such an account.
- The survey finds that adults in CDHPs are no more likely to have been uninsured before enrolling in their plans than those in more comprehensive plans. Ten percent of CDHP enrollees were uninsured before being covered by their current plan, compared with 20% of HDHP enrollees and 24% of individuals with more comprehensive plans.
- As in 2005, individuals in CDHPs and HDHPs continue to be less satisfied with various aspects of their health plans than individuals in more comprehensive health plans, are less satisfied overall with their health plan, and are less likely to recommend the plan to a friend or colleague.
- While the law that created HSAs allows people to have high-deductible health plans that cover the cost of preventive services — that is, preventive services are excluded from the deductible — more than half of individuals in CDHPs are in plans with deductibles that apply to all health services.
- Individuals in CDHPs and HDHPs are more likely than those with comprehensive health insurance to report that they delayed or avoided needed care because of cost. However, few differences were found among adults in the three plan types in reported use of health services and preventive care. Also, people in CDHPs and HDHPs are about as likely as those with comprehensive coverage to follow treatment regimens for a set of chronic health conditions that the survey asked about.
- As mentioned above, people in CDHPs and HDHPs exhibit more cost-conscious behavior in their health care decision making than those with more comprehensive health insurance. However, in many questions that addressed this issue, those in more comprehensive plans were just as likely to report such behavior as adults in consumer-driven or high-deductible health plans.
- Despite the emphasis on informed choice surrounding consumer-driven health care, people in CDHPs and HDHPs were less likely to report that their health plans provided information on the cost and quality of providers than those in more comprehensive plans.
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