Washington, D.C.—Enrollment in consumer-driven and high-deductible health plans increased in 2007, but still makes up a small segment of the overall insurance market, according to the third EBRI/Commonwealth Fund Consumerism in Health Care Survey released today. Enrollment in consumer-driven plans with a tax-advantaged account was 2 percent of the privately insured adults in 2007. One in 10 insured adults had high-deductible health plans (HDHPs) without accounts. The survey also found the percentage of consumer-driven plan enrollees with high incomes (above $100,000) swelled in 2007.
Consumer-driven plans were introduced in 2001 with the goal of decreasing the number of uninsured, encouraging cost-consciousness among consumers, and increasing the amount of information on the cost and quality of providers. The plans have been controversial because of criticism they favor wealthy and healthy participants at the expense of those with lower incomes and poorer health status.
Results of the survey appear in the March 2008 EBRI Issue Brief, available at www.ebri.org, and on The Commonwealth Fund Web site. The EBRI/Commonwealth survey found differences in the types of people enrolled in the various health plans. Consumer-driven plan enrollees are in better health, are less likely to smoke, are more likely to exercise, and to be white, male, and higher-income. They are no more likely to have been uninsured prior to enrollment than adults in other plans. In terms of behavior, enrollees in consumer-driven plans are more cost-conscious about their health care than are people enrolled in more comprehensive plans, are less satisfied with their plans overall ,and are more likely to say they avoided needed care because of cost.
Overall, the survey showed the following:
"Although consumer-driven plans have been around since 2001, market penetration is small," said Paul Fronstin of EBRI, lead author of the Issue Brief. "Employers, especially large employers, appear to be increasingly providing the plans as an option, but enrollment has yet to take off."
"These findings show that over the three years of the survey, more people in consumer-driven plans are earning higher incomes, tend to be healthier, and are no more likely to have been uninsured prior to enrolling than people in traditional health plans,” said co-author Sara Collins of the Commonwealth Fund. "These plans are not yet solving the problems they set out to address."
The survey produced these additional findings:
The EBRI Issue Brief notes that because the cost of health benefits has been increasing faster than inflation and worker earnings, employers have been seeking ways to manage the cost increases. Recently, more workers have been subject to higher deductibles and there has been growing interest among employers in offering health plans with deductibles that are even higher than what workers are used to seeing. Most of the activity in health plans that combine high-deductibles with a tax-preferred savings or spending account for health care expenses has taken place since 2004.
The third annual EBRI/Commonwealth survey is based on an online survey of 4,217 privately insured adults ages 2164 and was conducted August–October 2007. The sample was randomly drawn from Synovate's online sample of more than 2 million Internet users who have agreed to participate in research surveys. Additional information on the survey methodology appears in the March 2008 EBRI Issue Brief.