December 1, 2006
Paul Fronstin, Sara R. Collins
P. Fronstin and S. R. Collins, The 2nd Annual EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006: Early Experience With High-Deductible and Consumer-Driven Health Plans, The Commonwealth Fund, December 2006
A webcast of the release of this report at an EBRI/Commonwealth Fund briefing held December 7, in Washington, D.C., is available at www.KaiserNetwork.org.
This report presents findings from the Employee Benefit Research Institute/Commonwealth Fund Consumerism in Health Care Survey, 2006, the second annual version of this survey. The online survey of 3,158 privately insured adults ages 21–64 was conducted to provide nationally representative data regarding the growth of consumer-directed health plans (CDHPs) and high-deductible health plans (HDHPs), and their impact on the behavior and attitudes of health care consumers.
- Enrollment: Enrollment in CDHPs and HDHPs is virtually unchanged from 2005. Only 1 percent of the privately insured population ages 21–64 are currently enrolled in CDHPs, representing 1.3 million individuals ages 21–64. Another 7 percent, representing 8.5 million individuals 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.
- Impact on the uninsured: The survey finds that adults in CDHPs are no more likely to have been uninsured prior to enrolling in their plans than are those in more comprehensive plans. Ten percent of CDHP enrollees were uninsured prior to being covered by their current plan, compared with 20 percent of HDHP enrollees and 24 percent of individuals with more comprehensive plans.
- Lower satisfaction: As in 2005, individuals in CDHPs and HDHPs continue to be less satisfied with various aspects of their health plan 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.
- Preventive care not excluded from deductible: While the law that created HSAs allows people to have high-deductible health plans which cover the cost of preventive services (i.e., preventive services are excluded from the deductible), more than one-half of individuals in CDHPs are in plans with deductibles that apply to all health care services.
- More missed care: 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. Yet few differences were found among adults in the three plan types in reported use of health services and preventive care. In addition, 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.
- More cost-conscious behavior: Individuals in CDHPs and HDHPs exhibit more cost-conscious behavior in their health care decision-making than individuals 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.
- Availability of information: 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.