The EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (Consumer Engagement Survey) provides reliable national data on the growth of high-deductible plans and their impact on the behavior and attitudes of health care consumers with employment-based coverage or individually purchased coverage. It also looks broadly at consumer engagement and value-based health insurance design. Now in its 14th year, it is co-sponsored by the Employee Benefit Research Institute (EBRI) and Greenwald & Associates with support from six private organizations.
The 2018 survey was conducted online August 10‒23, using the Ipsos consumer panel. A total of 2,010 adults with private health insurance coverage through an employer, purchased directly from a carrier, or purchased through a government exchange participated in the survey. However, most survey participants (85 percent) received coverage through an employer. The data were weighted by gender, age, education, region, income, and race/ethnicity to reflect the actual proportions in the population ages 21–64 with private health-insurance coverage.
This Issue Brief identifies the key findings of the 2018 survey:
- HDHP enrollees have many characteristics equated with greater financial stability. HDHP enrollees have higher income and higher education than those enrolled in more traditional health coverage.HDHP enrollees are more likely than enrollees with more traditional health coverage to be employed full-time. Despite being slightly more likely to smoke, HDHP enrollees were more likely than enrollees in more traditional health coverage to report being in very good health.
- HDHP enrollees are more likely to seek cost information than traditional plan enrollees. More than one-third (39 percent) of HDHP enrollees versus 25 percent of traditional plan enrollees tried to find cost information in the last two years before receiving care.Among those who searched for information, HDHP enrollees were less likely than more traditional plan enrollees to have found such information.
- High-deductible health plan (HDHP) enrollees are more likely than traditional plan enrollees to exhibit cost-conscious behaviors. Those in a HDHP were more likely than those with traditional coverage to say that they had checked whether the plan would cover care or medication (55 percent HDHP vs. 41 percent traditional); checked the quality rating of a doctor or hospital before receiving care (41 percent HDHP vs. 33 percent traditional); asked for a generic drug instead of a brand name (41 percent HDHP vs. 32percent traditional); talked to their doctors about prescription options and costs (40 percent HDHP vs. 29 percent traditional); talked to their doctors about other treatment options and costs (37 percent HDHP vs. 31 percent traditional); asked a doctor to recommend less costly prescriptions (31 percent HDHP vs. 22 percent traditional); used an online cost-tracking tool provided by the health plan (25 percent HDHP vs. 14 percent traditional); or developed a budget to manage health care expenses (25 percent HDHP vs. 14 percent traditional).
- HDHP enrollees are more likely to delay care than traditional plan enrollees. HDHP enrollees were more likely to report that they delayed health care in the past year because of cost. One-third of HDHP enrollees reported delaying care, whereas 18 percent of traditional plan enrollees delayed care because of costs.
- HDHP enrollees are more likely to have and participate in wellness programs than traditional plan enrollees. HDHP enrollees were more likely than traditional plan enrollees to report that their employer offered them biometric screenings and were more likely to participate in such screenings. While they were also more likely to be offered reimbursement for all or part of fitness memberships, HDHP enrollees were less likely to report participating.
- HDHP enrollees are less likely than traditional plan enrollees to report that they do not have any major financial concerns. HDHP enrollees were more likely than traditional plan enrollees to report that they worry a lot about their finances and that debt is negatively impacting their ability to save for retirement.When it came to the top financial concerns, HDHP enrollees were more likely than traditional plan enrollees to report that they were concerned about not being able to retire when they want to, running out of money in retirement, not having enough money to cover out-of-pocket health care expenses not covered by insurance, and being laid off from work.Overall, a large majority of traditional plan and HDHP enrollees reported having major financial concerns.These findings may point to a broader correlation between financial wellness, plan design, and income that is not being captured by the survey findings.