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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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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 Plans:


Health plan definitions
Health Plan Definitions Health Plans:

  • 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 Health Plans: 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 Health Plans: 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 Plans: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 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.


Deductibles by type of health plan
Deductibles, by Type of Health Plan 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 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.


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.


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 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.


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 Benefits With No Choice of Health Plan, by Type of Health Plan

  • 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 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.


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 Was Available

  • 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: Was Available

  • 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.


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 Them Consider Cost When Deciding to Seek Health Care Services

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 Them Consider Cost When Deciding to Seek Health Care Services

  • 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 Them Consider Cost When Deciding to Seek Health Care Services

  • 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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