Early Experience With High-Deductible and Consumer-Driven Health Plans:
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Early Experience With High-Deductible and Consumer-Driven Health Plans: Findings from the EBRI/Commonwealth Fund Consumerism in Health Care Survey. Paul Fronstin, EBRI and Sara R. Collins, The Commonwealth Fund EBRI Policy Forum, Washington, D.C. December 8, 2005. Methodology.

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Paul fronstin ebri and sara r collins the commonwealth fund

Early Experience With High-Deductible and Consumer-Driven Health Plans:Findings from the EBRI/Commonwealth Fund Consumerism in Health Care Survey

Paul Fronstin, EBRI and Sara R. Collins, The Commonwealth Fund

EBRI Policy Forum, Washington, D.C.

December 8, 2005


Methodology

Methodology


Health plan definitions

Health Plan Definitions

  • Comprehensive – plan with no deductible or <$1000 (individual), <$2000 (family)

  • HDHP – plan with deductible $1000+ (individual), $2000+ (family), no account

  • CDHP – plan with deductible $1000+ (individual), $2000+ (family), with account


Respondent profile

Respondent Profile

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Respondent profile1

Respondent Profile

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Distribution of individuals covered by private health insurance by type of health plan

Distribution of Individuals Covered by Private Health Insurance, by Type of Health Plan

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Number of years covered by current health plan by type of health plan

Number of Years Covered by Current Health Plan, by Type of Health Plan

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Familiarity with consumer driven health plans

Familiarity with Consumer Driven Health Plans

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Deductibles by type of health plan

Deductibles, by Type of Health Plan

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Satisfaction with quality of health care received by type of health plan

Satisfaction with Quality of Health Care Received, by Type of Health Plan

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Satisfaction with out of pocket costs for health care by type of health plan

Satisfaction with Out-of-Pocket Costs for Health Care, by Type of Health Plan

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Satisfaction with choice of doctors by type of health plan

Satisfaction with Choice of Doctors, by Type of Health Plan

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Overall satisfaction with health plan by type of health plan

Overall Satisfaction with Health Plan, by Type of Health Plan

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Likelihood of recommending health plan to friend or co worker by type of health plan

Likelihood of Recommending Health Plan to Friend or Co-Worker, by Type of Health Plan

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Paul fronstin ebri and sara r collins the commonwealth fund

Likelihood of Staying With Current Health Plan If Had the Opportunity to Change, by Type of Health Plan

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Paul fronstin ebri and sara r collins the commonwealth fund

Agreement With Statements About Health Plan: Percent Reporting That They Strongly or Somewhat Agree, by Type of Health Plan

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Attitudes about consumerism and quality

Attitudes About Consumerism and Quality

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05 or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Paul fronstin ebri and sara r collins the commonwealth fund

Percentage of Individuals Covered by Employment-Based Health Benefits With No Choice of Health Plan, by Type of Health Plan

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Among individuals with a choice of plan reasons for choice

Among Individuals with a Choice of Plan, Reasons for Choice

  • Comprehensive

    • Low out of pocket costs, good benefits (54%)

  • CDHP (n=63)

    • Opportunity to save money in the account, and rollover funds for future years (62%)

  • HDHP

    • Cost of the premium (64%)

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Health plan choice and premium cost

Health Plan Choice and Premium Cost

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Percentage of individuals with comprehensive employment based health benefits offered cdhp or hdhp

Percentage of Individuals With Comprehensive Employment-Based Health Benefits Offered CDHP or HDHP

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Reasons hdhp members give for not selecting a cdhp plan that was available

Reasons HDHP Members Give for Not Selecting a CDHP Plan That Was Available

Note: HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Issues not addressable

Issues Not Addressable

  • Employer contributions

  • Individual contributions

  • Rollover amounts

  • Choice:

    • Reasons why those in CDHP chose plan

    • Reasons why those in comprehensive did not choose CHDP


Implications of consumerism for

Implications of Consumerism For:

  • Out-of-pocket costs

  • Access to health care services

  • Information on cost and quality of providers

  • Health care decision making


Percent of income spent annually on out of pocket medical expenses

Percent of Income Spent Annually on Out-of-Pocket Medical Expenses

Percent of adults 21-64 spending ≥ 5% of income

45*

29*

23

(n = 61)

20*

16

14

(n = 90)

11

8

5

15*

8*

1

6*

3

1

3

3

7

<$50,000 Annual Income

Total

Health Problem**

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

**Health problem defined as fair or poor health or one of eight chronic health conditions.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Percent of income spent annually on out of pocket medical expenses including premiums

Percent of Income Spent Annually on Out-of-Pocket Medical Expenses, Including Premiums

Percent of adults 21-64 spending ≥ 5% of income

92*

66

(n = 61)

53*

38*

42*

(n = 90)

34

31*

17

12

33*

21

18*

13*

12*

10

3

9*

4

<$50,000 Annual Income

Total

Health Problem**

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

**Health problem defined as fair or poor health or one of eight chronic health conditions.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Percent of adults who have delayed or avoided getting health care due to cost

Percent of Adults Who Have Delayed or Avoided Getting Health Care Due to Cost

Percent of adults 21-64

(n = 61)

(n = 90)

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

**Health problem defined as fair or poor health or one of eight chronic health conditions.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Percent of adults who have not filled a prescription due to cost

Percent of Adults Who Have Not Filled a Prescription Due to Cost

Percent of adults 21-64

(n = 90)

(n = 61)

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

**Health problem defined as fair or poor health or one of eight chronic health conditions.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Percent of adults who have skipped doses to make a medication last longer

Percent of Adults Who Have Skipped Doses to Make a Medication Last Longer

Percent of adults 21-64 with prescriptions in last twelve months

(n = 85)

(n = 50)

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

**Health problem defined as fair or poor health or one of eight chronic health conditions.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Availability and use of quality and cost information provided by health plan

Availability and Use of Quality and Cost Information Provided by Health Plan

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05 or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Most trusted sources for information on health care providers by insurance source

Most Trusted Sources for Information on Health Care Providers, by Insurance Source

Percent of adults 21-64

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Paul fronstin ebri and sara r collins the commonwealth fund

Percentage of Adults who Agree that Terms of Coverage Make Them Consider Cost When Deciding to Seek Health Care Services

Percent of adults 21-64 who strongly or somewhat agree

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Cost conscious decision making by insurance source

Cost Conscious Decision-Making, by Insurance Source

Percent of adults 21-64 who received health care in last twelve months

Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.

*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05

or better.

Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005.


Conclusion

Conclusion

  • Low diffusion of consumer-driven plans

  • Among adults with plans, lower satisfaction with quality of care, out-of-pocket costs, plan overall; few would recommend plan to friends/co-workers

  • High out of pocket costs + premiums amount to substantial share of income, especially among those with lower income and health problems

  • No differences in service use, but higher reported rates of cost-related delays, avoidance, or skipping care or Rx, esp. lower income and health problems

  • More cost-conscious decision making behavior

  • Little quality/cost information provided by plans

  • Consumerism gives disproportionate responsibility for cost control to those

    with health problems and low incomes


Acknowledgements

Acknowledgements

  • Dallas Salisbury, President & CEO, EBRI and EBRI-ERF

  • Karen Davis, President, The Commonwealth Fund

  • Cathy Schoen, Senior Vice-President, The Commonwealth Fund

  • Michelle Doty, Senior Analyst, The Commonwealth Fund

  • Jennifer Kriss, Program Assistant, The Commonwealth Fund

    Visit EBRI and the Fund at:

    ebri.org cmwf.org


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