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Participants Find Fault With Consumer-Directed Health Plans

Designed to hold down costs, the plans are prompting some people to forgo care, survey finds

THURSDAY, Dec. 8, 2005 (HealthDay News) -- Americans enrolled in new consumer-directed health plans are less satisfied with these plans than people who retain conventional comprehensive coverage, a new survey found.

Such findings raise concerns that the plans are causing people to forego needed care as they force more out-of-pocket costs for patients, according to the survey authors.

"Among adults who have the consumer-driven health plans, we are finding lower satisfaction with quality of care, out-of-pocket costs and a low satisfaction in their plans overall," said Sara Collins, the report's co-author and senior program officer of the Commonwealth Fund's Program on the Future of Health Insurance.

"Few people in these plans would recommend them to friends or co-workers," Collins added. "By focusing exclusively on the demand side, incentives give disproportionate responsibility on cost control to people with health problems or lower incomes."

Collins spoke at a news conference Thursday as the results of the survey, "Consumerism in Health Care Survey," were unveiled. The survey was conducted by the nonprofit Commonwealth Fund and the Employee Benefits Research Institute and was funded by the Commonwealth Fund, with additional support from IBM Corp., Pfizer Inc., and Procter & Gamble.

Overall premiums for health insurance have increased significantly in the last five years, far outpacing gains in worker income.

"The average premium for health insurance exceeds the annual income of a minimum wage worker," said Karen Davis, president of the Commonwealth Fund. It's not surprising, then, that the number of uninsured in the United States increased from 40 million in 2000 to 46 million today.

In their search for lower cost health insurance, some employers have started adopting consumer-driven health plans, namely high-deductible health plans (HDHPs), often in tandem with health savings accounts (HSAs). People can make pre-tax contributions to HSAs as a way to build up a nest egg for future medical expenses. Consumer-directed health plans, in general, are intended to foster cost-consciousness among health-system users.

"HDHPs with or without HSAs are being designed to try and control health-care costs from the demand side and they are really quite controversial at this point," Davis said.

"Proponents believe they will encourage individuals to become astute health-care consumers making decisions about health care on the basis of cost and quality, and in that way contribute to a slowdown in health-care costs," Davis added. "Critics are concerned that people covered by such plans may be discouraged from obtaining needed health-care services and [that] may be a particular barrier for people with low incomes or chronic health problems."

This Internet-based survey of 1,204 U.S. residents aged 21 to 64 was conducted in September and October. All participants had to have private insurance, and a high deductible was defined as $1,000 per individual and $2,000 per family.

About 1 percent of respondents were enrolled in a consumer-directed health plan, and another 9 percent in an HDHP without an associated HSA.

Among the survey's other findings:

  • Almost two-thirds (63 percent) of people with comprehensive health insurance were extremely or very satisfied with their health plan, compared with 42 percent of consumer-directed health plan participants and 33 percent of HDHP participants. The majority of people with comprehensive insurance (60 percent) said they were extremely or very likely to stay with their current health plan, compared with 46 percent of people enrolled in consumer-directed health plans and 30 percent of HDHP enrollees.
  • Consumer-directed health plan and HDHP enrollees spent more of their income on out-of-pocket health-care costs plus premiums, with 42 percent of HDHP individuals and 31 percent of CDHP individuals spending more than 5 percent of their income on such costs, versus 12 percent in comprehensive health plans.
  • More individuals with consumer-directed health plans and HDHPs went without health care or delayed health care due to cost considerations. This problem was most acute among people with chronic health problems and those with annual incomes under $50,000.
  • About one-third of individuals in consumer-directed health plans (35 percent) and in HDHPs (31 percent) reported delaying or avoiding care, compared with 17 percent of those in comprehensive health plans.
  • More than 70 percent of individuals enrolled in consumer-directed health plans and 60 percent of those in HDHPs strongly or somewhat agreed that the terms of their health plans made them more cost-conscious when considering care. Less than 40 percent of those in comprehensive health plans felt this way.
  • Few people (1 in 7) in all types of plans said the plan offered information on hospitals and doctors.

The survey results are in contrast to a Blue Cross/Blue Shield survey released in September that found that HSA enrollees expressed greater satisfaction than non-consumer-directed health plan enrollees in overall satisfaction with their plan, responsiveness of customer service, information provided on health-care benefits and access to preventive care and wellness services.

The survey was criticized by proponents of consumer-driven plans.

"If someone is going to get free health insurance, they would rather have it be comprehensive than have a cost-sharing provision. But the reality is you don't get free health insurance," said Greg Scandlen, founder of Consumers for Health Care Choices, in Hagerstown, Md. "You're required to pay or your employer is required to pay and reduce your wages."

More information

Find more on the report at the Commonwealth Fund.

SOURCES: Greg Scandlen, founder, Consumers for Health Care Choices, Hagerstown, Md.; Dec. 8, 2005, press conference with Karen Davis, Ph.D., president, the Commonwealth Fund, and Sara Collins, Ph.D., senior program officer, Program on the Future of Health Insurance, the Commonwealth Fund
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