'Consumer Engagement in Health Care: The Use of Lower Cost Sharing,' and 'Income of the Elderly Population Age 65 and Over, 2007'

Many Americans support the use of lower cost sharing as an incentive to change the way individuals use the health care system in order to reduce costs, according to survey data published today by EBRI. <A href="http://www.ebri.org/pdf/PR.839_05May09.CstShrg.pdf">Press release </A>

Consumer Engagement in Health Care: The Use of Lower Cost Sharing

THE 2008 EBRI/MGA CONSUMER ENGAGEMENT IN HEALTH CARE SURVEY: This survey examined opinions regarding the appropriate use of lower cost sharing as an incentive to change the way individuals use the health care system.

HIGHLIGHTS: More than half (58 percent) of individuals support lower cost sharing for patients who actively participate in a program to maintain or improve their health; 40 percent support lower cost sharing for patients who use treatments that have been scientifically proven to be effective for their medical condition; one-third (34) percent support lower cost sharing for patients who choose to see high-performing health care providers; and about one-half (47 percent) support lower cost sharing for patients who choose less invasive procedures to treat their medical conditions.

HEALTH AFFECTS OUTLOOK: Persons who self-rate their health status as excellent or very good are more supportive of lowered cost sharing than those whose health not as good. Obese individuals and smokers are generally less likely than those who are not to support lowered cost sharing for engaged patients.

GENDER/AGE: Men are much more likely than women to think that cost sharing should vary with an individual’s level of engagement in their own health care. Younger individuals are generally more likely than older individuals to support lower cost sharing for those who comply with patient engagement rules.

RACE/ETHNICITY: Asians are across the board more likely than other race/ethnic groups to support the concept. Non-Hispanic blacks were least likely to support lower cost sharing, while Hispanics and non-Hispanic whites were in the middle.

Income of the Elderly Population Age 65 and Over, 2007

IMPORTANCE OF SOCIAL SECURITY: In 2007, Social Security continued to be the largest source of income for those currently age 65 and older, accounting for 38.6 percent of their income on average. Pension and annuity income was 18.6 percent, income from assets 15.6 percent, and income from earnings was 25.3 percent.

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Howev cent oppose it er, they a , and 35re perce less likely to nt neither think that support By Ken McDonnell, EBRI The Use of Lower Cost Sharing Distribution of the Older Population's Income, 2007 Income of the Older Population, Selected Years 1974–2007 ww nor opp there sho w.abouts ose it. uld be low chwab.com Less sup er cost s / pme ort dia/ h was found for aring for pd Persons Age 65 and Over, by Martial Status, 2007 f/Youn per gA sons who lower dults_ cost sha and_M use o high neyFactS ring for -performi pati heeen ng providers, scientifica t.pdf ts who use scientifically lly proven proven tre treatm atments ents, or Employee Benefits Congressional Hearings of Note By Paul Fronstin, EBRI (2008 $s) The Marital Stat followin us g ? sections exam Nonmarried persons r ine how the ecei support ve a larger for low share of their er cost shari inncome from g related to So patient cial Security t engageh ment vari an married persons es by health 100% less-invasive procedur (40 percent) and for patie es. nts who use high-performing providers (34 percent). For both questions, one-quarter The U.S. retirement income system—including employment-based retirement plans, Social Security, individual saving, st May 2009 • Vol. 30, No. 5 Employee Ben $35,000 efit Research Institute. Fundamentals of Employee Benefit Programs. Sixth Edition. $19.95 (EBRI House Ways and Means Committee: Health Reform in the 21 Century: Reforming the Health Care Delivery System s Samp Congressional (45. tatus 7 perc and le Med ent behaviors i Research vs. 34.2 a Cov,erag demo pe Serv rce e graph of n ice: t), a the 2009 i n cs, an d a noti d Retirement C work status va ceably smaller 1.7% riables. o sh nfare idence from Surv earnings 2.1% ey (18.0 percent vs. 29.8 percent) (Figure opposed the lower cost sharing, and 35–40 percent neither su Other pported nor opposed it. and post-retirement employment—can be assessed in part by examining the income of the current elderly population 90% members get a 55 percent discount) plus shipping. EBRI me 1.8% mber organizations, or those interested in bulk purchases (April 1, 2009): http://waysandmeans.house.gov/hearings.asp?formmode=detail&hearing= 18.0% 670 6). Early Wit In additio hdra n, marrie wals an d d per Requ sons receive ired Minimum a slightly Distributio smalle nr share s in Reti of th rement eir i n Accounts: Issues for Co come from pensions an ngr d an ess nuities. Where the world turns for the facts on U.S. employee benefits. (age 65 and older). This article reviews the latest available data on the older population's income (from the U.S. $29,214 Associated Introduction Demographics Press: www.google.com/hostednews/ap/article/ALeqM5hWfCM1tcJYNZv4Sq4t1uALg__bmgD97I1GS82 of Fundamentals, should contact Alicia 29.8% Willis at (202) 659-0670 or e-mail: publications@ebri.org. To place individual Employers an http://assets.opencrs.com/r $30,000 d insurers are going to co pts/R401 nti 92 nue _2009 experim 0204.p enting wi df th various ways in which they can use features of their Census Bur 80% eau’s March 2008 Current Population Survey) and how it has changed over time, as well as how the elderly's House Education and Labor Committee: 401(k) Fair Disclosure for Retirement Security Act of 2009 (April 22, 2000): Earnings $26,714 Gender ?Elderly women derived a greater share of their income from Social Security and assets th $26,768 an elderly men in orders online, contact publications@ebri.org or go to www.brightdoc.com/ebri Men ar Employers hav e clearly much mor e been interes e lited i kely tha n brin n women to t ging aspects o hink f co that cost shari nsumerism int ng shou o healt ld var h plans y with for ma an in ny yea dividual rs. As far ’s level o bac f k as benefits plan to increasingly engage workers and their families in their health care in order to manage health care costs Retirement and health benefits are at the heart of w 25.3% orkers’, employers’, and our nation’s reliance on these sources varies across demographic chFig aracteristics. ure 1 Other Bloomberg News: www.bloomberg.com/apps/news?pid=20601103&sid=aalioI1L1WoQ&refer=news Figure 5 15.8% http://edlabor.house.gov/hearings/2009/04/401k-fair-disclosure-for-retir.shtml Old-Age, Survivors, and 2007. Soc Unemploymen ial Security acco t and Healt unted h Infor surance: 46.3 percent Current Legislatio of elderly wome n and Issues n's income, compared with 33.0 percent of elderly $24,162 enga 1978, they a gement i 70%dn opted Sec. their own 125 cafeteria health care. M pla en n were s and fl across the exible spen board ding acc 10–o15 unts. 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Earnings Thompson Reuters: http://uk.reuters.com/article/gc04/idUKTRE53D5OW20090414 The Use of Lower Cost-Sharing, p. 2 House Energy and Comm to Enga erce Healt ge h Cons 15.5% Subcommittee: umers in Ma Ma king H naging He ealth Caa re lth Work for Care Cos Am 38.6% erican ts, 20 Famil 08 ies: The Role of 60% Hewitt Associates LLC, Attn: Hewitt Information Desk, 100 Half Day Rd., Lincolnshir 1 e, IL 60069, (847) 295-5000, $19,740 by Source and Age, 1975, 1985, 1995, and 2007 13.8 percent of elderly men’s. By comparison, elderly men derived a larger share of their income from employment- consumers in were able to start offerin managing hea g he lth care alth plans costs wit(Fi h hea gure 3 lth savin ). gs accounts (HSAs). By 2008, 9 percent of employers with $18,782 Income Sources $20,000 18.4% Public Health (March 31, 2009): Economic Policy Institute: Who Is Adversely Affected by Limiting the Tax Exclusion of Employment-Based Premiums? e-mail: BenefitSpecSelect@Hewitt.com, www.hewitt.com based sources, including pensions and annuities and earnings, than elderly women. In 2007, pensions and annuities 70% 1975 1985 Income from 1995 2007 10–49 EBRI focus 9 workers and es solel 20 percy ent of on emplo those w yiee th 5 benefits research — no lobb 00 or more workers offered either an ying HRA or HSA or advocacy -eligible plan, covering Wall Stre EBRI Emplo et Journal: yee Benefit Res http://online. earch Institute Notes wsj.com/article/SB1 (ISSN 1085 239672 -4452) is published monthl 08769515763.html?mod y by the =googl Emplo ene yee Benefi ws_wsjt Research 50% In 2007, Social Security was the largest source of income for those currently age 65 and older, accounting for 38.6 per- http://energycommerce.house.gov/index.php?option=com_content&task=view&id=1559&Itemid=95 th Assets Endnotes [Working Paper] www.epi.org/page/-/pdf/wp281.pdf Income of the Elderly Popul 2 ation Age 65 and Over, 2007, p. 9 With respect to age, there a Income re some Percentage patterns. You Income nger indivi Percentage duals are ge Income nerally mor Percentage e likely tha Income n older individua Percentagels to accounted for Institute, 1100 13 20.7 percent St. NW, Suite 8 of elderly 78, Washington, men's income, DC 20005 com -4051, pared at $300 pe with 15.r 9 percent year or is included as of elderly part of a mem women’s. Incom bership e from EBRI stands alone in employee benefits research as an independent, nonprofit, and nonpartisan 7 percent of all workers. $17,898 18.8% 1 $17,560 cent of their income on average (Figure 1). Pension and annuity income was 18.6 percent, income from assets 15.6 $17,146 subscription. Periodicals postage rate paid in Washington, DC, and additional mailing offices. POSTMASTER: Send address More info Age 65–69 rmatio $15,000n about HRAs and HSAs can be found in Pa $16,584 ul Fronstin, $16,324 Consumer Driven Health Benefits: A Continuing Pensions and support lower 40%orga cost sharing f nization. It analyzes a or individuals nd rep who com orts re ply sea with r the various ch data without spin o ideas for patient enga r underlying a gement. Ho genda. All fin wever, ding the s, Washin gton Post: www.washingtonpost.com/wp-dyn/content/article/2009/04/14/AR2009041402854.html earnings accounted for 30.4 percent of the elderly men's income, compared with 18.3 percent of elderly women’s. th 58% 58% $15,436 60% Senate changes to: Commerce, Sc EBRI Noienc tes, 1100 13 e, and Transport St. NW, Suite 8 ation Committ 78, Washington, ee: Annuities AgDC 20005 ree -4051. Neither Agree nor Dis Copyright 2009 b agree y EmployeDis e Ben agree efit Hewitt Associa percent, and intes: S come f prom e ecial R arnings eport: was The Am 25.3 erican percent. Recovery and Reinvestment Act of 2009 and Its Impact on Employers Evo Employee Stock Ownership Plans (ESOPs) lution? Total income (Washington, DC: Employee Benefit Research In $5,404 100.0% $12,783 stitute, 100.0% 2002); and Pa $20,005ul Fronstin, “Health Savings Accounts and 100.0% $34,078 100.0% whether on financial data, options, or trends, are revealing and reliable — the reason EBRI information is relationshi Concurrent p wi is th the movem not completele ynt toward ac linear. $13,666 For e count-based plans, xample, there is a li or near “cons rela umer-driven tionship bet ” w health een a pla ge and su ns as they ar pport for e mor lowe e r cost Research Institute. All rights reserved, Vol. 30, no. $13,311 5. New Publications and Internet Sites, p. 15 • Other Account-Based Health P Part I: Social Security Deceptive Health 1,864 In lans,” dustry Practices EBRI Issue Brief 34.5 – Ar 4,326 no. 273 (Washington, DC: Employ e Consumers Getting 33.8 6,632 What They Pa ee Benefit Research Institute, 33.1 id For? 9,649 (March 26, 20 28.3 09): www.hewittassociates.com/ 30% _MetaBasicCMAssetCache_/Assets OASDI /Legislative%20Updates/2009/Special_Report_American_ the gold standard for private analysts and decision makers, government policymakers, the media, and Median Total Income For e The Natio lderly me nal Center n, income for Em froployee m earni Own ngs e (e rsmployment hip. Issue in Brcome ief: The ) has inc State of reased si Employe gnie fic Ownershi antly as a p 20 per09 centage of [25-page inc printout, ome sharing frequently for call $10,000 patients pa ed, employers rticipating have in incre a he asingly alth pro focuse gram d t beh twee eir att n a eg ntion es 1 8more broa –54. Over dly 60on consumer percent of in enga dividuals a gement i ges n1 hea 8–2l4 th Pensions 798 Income From Assets 14.8 2,224 17.4 3,661 18.3 5,555 16.3 September 2004). Nearly all individuals (89.3 percent ) age 65 and over were receiving income from Social Security in 2007 (Figure 2), http://commerce.senate.gov/public/index.cfm?FuseAction=Hearings.Hearing&Hearing_ID=4edbd03a-bf22-4783- Recovery_and_Reinv the publi estment_Act.pdf c. 50% 15.6% 45.7% ASE not a boun C Activiti d book]. es: NCEO members, $15; nonmembers, $25. 47% National Center for Employee Ownership, 1736 Franklin from 1985 (18.9 percent) to 2007 (30.4 percent). Correspondingly, their income from assets has declined as a support lower care. In 2001, employ Assets cost sharing ers for 841 fom r ed a individu coalit 15.6 als actively partic ion to re2,902 port heal ipatin th car 22.7 g in e h provi ealth d pro 3,184 er qual grams, c ity me 15.9 oas mpared with ures, and 4,765 to57 day th perce ent am 14.0 groupong is 20% Average Total Income 2 while 52.9 percent received income from assets, 34.3 percent received income from pensions and annuities, and The Employee Benefit Research Institute (EBRI) was founded in 1978. Its mission is to 87d th b-dfd57d980123 See www.mercer.com/summary.htm?idContent=1328445 34.2% 3 Washington Watch, p. 17 Th perce St., 8 e Amer ntage Floor, Earnings ican of Oakland, income from 1 Savings Educ CA 9 1,711 461 ation Cou 985 2, (21. (510 1 31.7 n) cil’s per 208- c Spri ent) 13ng 2 00, to 200 2,957 fax: 0097 (13. (51 Partners M 0) 23.1 8 perc 272-9 e ent). 5 eti 10 n, e 6,089 g was h -mail:e nce ld A 30.4 op@nceo.org, ril 15, wit 13,607 h 8 ww 1 in w.nceo.or dividuals 39.9 g 25– composed 44 year o not lds, and only of 5 em 4 per ploc yent amon ers but also g 4of consumer 5–54 year ol groups an ds, but the d or perc ganize entage suppor d labor. ting t In 2005, em he lowepl r cost sharing oyers started to $5,000 contribute to, to encourage, and to enhance the development of sound employee benefit 40% 40% Internal 19.9 percent Reve rnue eceived i Service: ncom Premium e from earn Assin istgs. ance for COBRA Benefits [Notice 2009-27] 3 EBRI explores the breadth of employee benefits and related issues Other 191 3.5 375 2.9 439 2.2 502 1.5 10% Pensions and Annuities attendi See Who we are www.healthcaredisclosur ng. Presentations, handouts, e.org/ documents, and Web sites mentioned during the meeting are online at 40% programs and sound public policy through objective research and education. EBRI is the only increases to focus on value- 64 percent based insurance among 55 de–64 sign year s (VBIDs) that se olds. ek to encourage the use of high-value services while • Part II: Deceptive Health Industry Practices – Are Consumers Getting What They Paid For? (March 31, 2009): www.irs.gov/pub/irs-drop/n-09-27.pdf 18.6% EBRI studies the world of health and retirement ben 35% efits — issues such a 35% s 401(k)s, IRAs, retirement Age 70–74 The percentage of elderly women’s income coming from employment-based sources, has increased over 34% time, reflecting private, nonprofit, nonpartisan, Washington, DC-based organi 4 zation committed exclusively to 4 www.ebri.org/pdf/spring2009.pdf discouraging the use of services w hen the benefits are not justified by the costs. A recent study found that 20–30 per- See Michael E. Chernew, Allison B. Rosen, and A. Mark Fendrick, “Value-Based Insurance Design,” Health Affairs Web http://comme incom rce.senate. e adequacy, co gov/pu nsu blicm /in er-drive dex.cfm?FuseAct n benefits, Socia ion=Hearin l Security, tax treatment of both retireme gs.Hearing&Hearing_ID=63b0f558-ec43- nt and health 4ab8- Total income $0 4,651 100.0 11,286 100.0 17,388 100.0 27,102 100.0 0% EXEC UTIV E SUMMAR Y public policy research and education on economic security and employee benefit issues. the Executive Compensation growing presence of women in the work force. In 1975, pensions and annuities accounted for 11.9 percent of When examining support for use of lower cost sharing for ind 5 ividuals engaged in various aspects of their health care, Exclusive (January 10, 2007): w195–w203. 28% 1974 1979 28% 1984 1989 1994 1999 2004 2007 cent of 30% large employers use some from o Married Couples f VBID strategy. Nonmarried Persons Kaiser Family Income Levels Social Security benefits, cost Foundation:2,135 manage National Healt ment 45.9h , worker a Insura 5,009 nce— nd employe A Brie44.4 f History r attitude of 7,416 Reform s, policy reform p Effo 42.7 rts in th ropo e U.S 10,558 sals, and p . 39.0 ension assets EBRI’s membership includes a cross-section of pension funds; businesses; trade associations; 82f0-070bcc699e38 elderly women’s income and earnings accounted for 11.0 percent. By 2007, these percentages had increased to 25% Watson Wyatt Worldwide. Executive Compensation in Uncertain Economic Times: 2008/2009 Report on Executive Pay. Asians are acr 5 oss the board more likely than other race/ethnic groups to support the concept. Non-Hispanic blacks Source: EBRI estimates from the March 2008 Current Population Survey. 24% Pensions and funding. There is wi 670 14.4 despread 1,821 recognition that if employee be 16.1 3,747 ne21.5 fits data exist, EBRI kno 5,309 19.6ws it. labor unions; health care providers and insurers; government organizations; and service firms. www.kff.or Niteesh K.g/h Cho eu althreform/u dhry, Meredipload/7871.pdf th B. Rosenthal, and Arnold Milstein, “Innovative Ideas Around Value-Based Insurance Designs,” Source: EBRI estimates of the March 2008 Current Population Survey. The median income lev Source: EBRI estimates of the March 1975, 1980, 1985, 1990, 1995, 2000, 2005, and 2008 Current Population Survey. el (mid-point, half above and half below) of the elderly population increased from $13,311 (in 6 Social Media 15.9 percent a Sites nd 18.3 percent, respectively (Figure 7). were Consumer Engagement in Health C $45. This re least Watson Wyatt Worl port Assets like presents fi ly to support Data are in 2005 dollars. ndidwi ngs from th 957 ld oe, 90 wer cost sh 1 N. Gle e 2 20.6 0a 08 EB ring, be Rd., RI/M whi 2,886 are: The Use Ar le H GA linigt spanics a Consumer En on, VA 25.6 22 nd no 20 of Lower Cost gageme 3, n-Hispan (800 3,072) nt in 38 ic 8- H whi 98 e 17.7 alth C t68 or es wer Sharing (70 are e i3 Sur n 4,338 ) 2 th v5 e middl ey, 8-8 foc 000, f e16.0 u . sing ax: (703 on ) unpublished m anuscript (November 11, 2008). 18% constant 2 20% 008 dollars) in 1974 to $17,560 (in 2008 dollars) in 1999 (Figure 3). By 2004, the median income of the Earnings 714 15.4 1,256 11.1 2,724 15.7 6,528 24.1 258-8585, www.watsonwyatt.com pubic o EBRI delive pinion regarrd s a stead ing variation in y stream of invaluable research and anal EBRI’s work advances knowledge and unders cost sharing as it relates to consumer engatanding of emplo gem ysis ent in healthyee benefits and their care. The Lewi 6 n Group: The Cost and Coverage Impacts of a Public Plan: Alternative Design Options Notable Government Documents Available Online 14% More information about the survey can be found in Paul Fronstin, “Findings from the 2008 EBRI Consumer Engagement in elder ly had declined to $17,146. Real median income increased by 2007, to $17,898, the highest point in this time EBRI’s Twitter page is @EBR 13% I (if on Twitter) or can be found on the Web at http://twitter.com/EBRI Other 174 3.8 313 2.8 429 2.5 369 1.4 Concerni THE 2008 EBRI ng education, th /MGA CONSUMER ENGA ere was no importance to clear GEMENT I -cut patt the nation’s econo ern N HE acr ALTH oss the fiv CARE my among policy SURVEY: e questions on This survey e makers, lower cost sh the news xamine media, and ari d opinions ng and incr the public. It regardin eased g EBRI publications include in-depth coverage of key issues and trends; summaries of research www.lewin.com/content/publications/LewinCostandCoverageImpactsofPublicPlan-Alternative%20DesignOptions.pdf Health Care Survey,” EBRI Issue Brief, no. 323 (Employee Benefit Research Institute, November 2008). Age 75–79 se Bureau ries. of Th Labor Statistics e average income of Program P the ele drspectives: erly increase De dfine from d-Contr $18,7ibutio 82 in 197 n Plans Mor 4 to $24,1 e C62 by 198 ommon Tha 9. nF Defi ollowin ned-B g 19 ene 89, fit Plans: Additiona l Data does this by conducting and publishing policy research, analysis, and special reports on patient the a 10% ppro enp ga riat gement e use of in lower health cost sharin care. Highly g as an i educate ncentiv d indi e to viduals ar change t e mo he way re like in ly tha dividu n l als use th ess educat e he ed i alth car ndividuals to e syste m. What we do findings and policy developments; timely factsheets on hot topics; regular updates on legislative and ® Toal income 4,322 100.0 10,243 100.0 15,651 100.0 23,459 100.0 Choose to Save is now on Facebook ( emplo htt yee benef p://www.f its issues; holding educational br acebook.com/home.php?#/ iefings for EBRI memb pages/Choose-to-ers, congressional and www.b average ls.g incom ov/op e of ub/ the persp elderl ectives/ y was u issue3.p p and dfdown, being higher in 2007 than in 1989 by $5,052 (calculated from regulatory developments; comprehensive reference resources on benefit programs and workforce Health Care support For additlower ional data on incom cost sharing for pati e source ents ac s of the eld tively participat erly, please see the ing in a health EBRI Databook program. In on Employee contrast, less Benefits educat, Cha ed indiv pters 6 iduals MetLife: Seventh Annual Study of Employee Benefits Trends: Findings from the National Survey of Employers and Questions Addressed Social Security 2,115 48.9 4,821 47.1 7,746 49.5 10,712 45.7 federal agency staff, and the news media; and sponsoring public opinion surveys on employee Save/56756038533?ref=ts), Twitter (http://twitter.com/choosetosave), and YouTube (www.youtube.com/ctspsas) Figure 3). issues; and major surveys of public attitudes. are more and 7. w like ww.lebri.or y than ghighly /publiceducat ations/books/i ed indivin duals to dex.cfm?fa support =databook lower cost sharing for patients who choose less-invasive Employees Pensions http://whymetlif 562 e.com/tren 13.0 ds/downlo1,512 ads/MetLife_EB 14.8TS09.pdf 3,033 19.4 4,821 20.5 Buck Consult 0% ants. Working Well: A benefit issues. Global Survey EBRI’s Ed of Health Promotio ucation and Re n and searcWorkplac h Fund (EBRI-ERF) performs e Wellness Strategies the char . $150. itable Buck , The HIGHL 20IG 08HT EBR S: More t I/MGA Cons han hal umfer Eng (58 percent agement i ) of in n Hea dividuals lth Care support Survey examined o lower cost sharing for pati pinions regar ents wh ding the a o actively ppropriat part e use of icipate Congressional Budget Office: Historical Effective Federal Tax Rates: 1979 to 2006: EBRI meetings present and explore issues with thought leaders from all sectors. Assets 973 educa 22.5 tional, and scientif 3,099 ic func 30.3 tions of the Instit 3,135 ute. EBRI 20.0 -ERF is a tax-ex 4,056 empt organization 17.3 Lower Cost Sharing for Lower Cost Sharing for Lower Cost Sharing for Lower Cost Sharing for Lower Cost Sharing for procedures. There is no clear pattern with respect to household income as well. Consultants, an ACS Company, Attn: Global Survey Resources, 500 Plaza Dr., Secaucus, NJ 07096-1533, (800) 887- lower cost sharing as an incentive to change the way individuals use the health care system. The survey asked a series in a program to maintain or improve their health; 40 percent support lower cost sharing for patients who use http://cbo.gov /ftp EBRI regula docs/100xx/doc rly provides 10068/effective congre _s tax_r siona Figure 7 al testimony tes_2006.pdf , an d briefs policymakers, member organizations, Active Patients Pat supported b ients Follow y ing contributions Less Inv and g asivr e Proc ants. edures Scientifically Proven High-Quality Doctors Earnings 449 10.4 548 5.4 1,343 8.6 3,331 14.2 PensionTsunami.com: PensionWatch: Newsclips FocusiFigure 2 ng on Public Employee Pensions, Corporate Pensions, Social 0509, www.bucksurveys.com and the medi Distribution of the Older Population's Average Annual a on employe Treatment Regim r benefits. ens Effective Care a qu treatments th estions regardi at have ng wh been eth scientifica er individuals lly proven to agreed or be disagr effective eed for with thei var r medical co ious ways pati ndition; on ents coul e-th d rir ed ce(34 ive lo per wer cent cost ) Income Composition Other 223 5.2 262 2.6 394 2.5 540 2.3 Security, and International Trends Percentage of the Older Population Receiving www.pensiontsunami.com/ Income, by Source and Gender, Various Years EBRI issues press releases on newsworthy developments, and is among the most widely quoted Department of Labor Employment & Training Administration: Comparison of State Unemployment Laws: sharing. Age 80–84 Specifically, adults with private insurance were asked whether they agreed with the following statements: support lower cost sharing for patients who choose to see high-performing health care providers; and about one-half Work Status EBRI Issue Briefs are periodicals providing expert evaluations of employee benefit issues and Income Group ?Income composition varies significantlyFigure 4 across income groups. In 2007, the lowest income quintile International Foundation of Employee Ben Income From Various Sources, 2007 efit Plans. Males Health Care Cost Control: Indu Females stry Approaches and Attitudes. sources on employee benefits by all media. Sour Total income ce: 2008 EBRI/MGA Consum 4,107 er Engagement i 100.0 n Health Care Su9,869 rvey. 100.0 14,268 100.0 22,724 100.0 www.ows.doleta.gov/unemploy/uila trends, as well wcompar/2009 as cr/comparison20 itical analyses of 09.as emplo py ee benefit policies and proposals. EBRI Notes is a (47 percent) support lower cost sharing for pati Income ents who choose less i Percentage nvasive proce Income dures to tr Percentage eat their medical Our Retirement USA: Principles Income of the Elderly, Lowest and Highest Quintiles, 2007 for a New Retirement System [Working Paper] among t Figure 4 co he nta elderly rec ins the fi eive ndid n 8 gs on support 8.7 percent offo its incom r lower cost e fro sh m aring for var Social Secuious pati rity, and the ent e h nigagement ghest income concepts quintilby e re firm ceiv size ed IFEBP memb 100%e rs, $67; EBRI direct nonmembers, s membe $1r00. s a Intern nd other constit ational Foun uen dation cies to the informatio of Employee Benn they need, an efit Plans, Publications d undertakes new Social Security 1975 Data 2,088 monthly 50.8 periodical providing cu 4,772 48.4rrent information on a variety 7,930 55.6 of employ 10,959 ee benefit topics. 48.2 • Patients who are actively participating in a program to maintain or improve their health should pay less for medical conditions. Total income $6,929 100.0 $3,209 100.0 www.retirement-usa.org/wp-content/uploads/2009/03/working-paper-031209.pdf 17.2 percent and annual e o arnings. f its income For th from Social ree of the Sec fiveu qu rity (Fi estions on gure 4 l)o . wer cost sh The other t ah ring and patie ree main sources of t nt engagemen he elderly's incom t, workers em e ployed research on an ongoing basis. Pensions 519 EBRI’s 12.6 Pension Inv 1,153 estment Re 11.7 port provides detailed fin 2,398 16.8 ancial information on th 4,606 e universe of 20.3 Department, P.O. Box 68-9953, Milwaukee, WI 53268-9953, (888) 334-3327, option 4; fax: (262) 786-8780, e-mail: publications Social Security Administration: Social SecuritySocial Security Bu 2,496 lletin: Annual 36.0 Statistical Supplemen 1,668 t, 2008: 52.0 services than a patient with the same health issues who is not participating in a health program. 89.3% 90% Pensions and annuities defined benefit, defined 1,054 contri 15.2 bution, and 401(k) plans. EBRI 382 Fundamentals of Employee 11.9 Assets EBRI maintains an 941 d analy 22.9 zes the mo 3,224 st comp 32.7 rehensi 3,019 ve database 21.2 of 401(k) 3,915 -type program 17.2 s in the (pe in lar nsions an ger firms d annu are mor ities, ass e likely e to support t ts, and earnih ne lo gs) all werincre cost ashar se in ing than importan workers in ce for the smaller higher-incom firms. e Workers in quintiles. In larger firms 2007, the books@ifebp.org, www.ifebp.org/bookstore www.socialsecurity.gov/ Assets policy/docs/statcomps/supplemen 1,345 t/2008/index.html 19.4 613 19.1 Benefit Programs offers a straightforward, basic explanation of employee benefit programs in Robert Wood Johnson Foundation and Urban Institute: How Effectively Does The American Recovery and Earnings world. Its co 269 mputer simul 6.6 ation analy 408 ses on So 4.1 cial Secu 716 Highest-Income Quintile rity reform 5.0 and retireme 2,669 nt income a 11.7 dequacy HEALTH AFFECTS OUTL Earnings OO Lowest-Income Quintile K: Persons who self-rate their 1,796 healt 25.9 h status as excellent 351 or very good 11.0 are more supportive of lowest-i were more lik ncome ely than quintile work receers in smal ived 2.6 peler rcent firms to su of its income pport lo from pensions wer cost sharing for and annuities patients actively , 4.4 percent participati from assets, and ng in a • Patients should pay less for their treatments when the treatments have been scientifically proven to be effective for Health Status and Behavior Other 237 3.4 194 6.1 80% the private and public sectors. The EBRI Databook on Employee Benefits is a statistical (Greater Than $37,062 in 2007) Other (Less Than $8,339 in 2007) 290 7.1 311 3.2 206 1.4 575 2.5 Reinvestment Act are uni Help Laid-Off Workers a que. nd States Cope with Health Care Costs? lowere d cost sharing than those whose health is not as good. Obese individuals and smokers are generally less likely than 1985 Data 1.8 perc health pro ent fr gram, patients who use t om earnings. By comparison reatments that , the highest-i have be ncome en sciquinti entific le ally prov received 21. en to be 0 perc effectiv ent oe f its for the income ir me from dical The White House: Executive Order: Establishment of the White House Office of Health Reform: their medical condition, and pay more reference work o for treatments tha n employee ben t are efit pr proven ograms and to be work force-related issues. less effective for their condition. Age 85+ Generally, persons who self-rate their health status as excellent or very good are more supportive of lowered cost Total income 14,748 100.0 8,845 100.0 www.rwjf.org/files/research/20090318quickstrikearra.pdf those who are not to support lowered cost sharing for engaged patients. Earnings Other pensions a Human R condition, an nd d for e annuiti source Management patie es, 2 Social Security nts w 1.8 percent ho choose fro high-performi m assets, and 5,443 ng 38.1 provid percent 36.9ers. T from earni here was no 4,120 ngs. pa ttern of 46.6 support by firm size for www.whiteho 70% use.gov/the_press_office/Executive-Order-Establishing-The-White-House-Office-Of-Health-Reform/ Total income 3,581 100.0 9,172 100.0 13,511 100.0 21,120 100.0 sharing than those who rate their health as good, fair, or poor. Those in 38.1% excellent or very good health are more likely EBRI makes information freel Pensions and annuities y available to al 2,998 l 20.3 897 10.1 1.8% Pensions and • Patients Social Security who choose to see 1,877 medical providers that ar Contact EBRI 52.4 Publications, (2 4,416 e iden 48.1 02) 659-0670; tified as hi 7,625 gh-performi fax publication 56.4 ng should orders to 11,423 pay l (20 ess than 2) 775-6312. 54.1patients lower cost sharing for pati Assets ents who choose less-invasive 3,116 proced 21.1 ures and for thos 2,917e who follo 33.0 w treatment regimens. Wats on Wyatt Worldwide. The Power of Integrated Reward and Talent Management: 2008/2009 Global Strategic EBRI assumes a public service responsibility to make its findings completely accessible at www.ebri.org to support Vanguard Inv lower cost shari estment Coun nsg eling & Rese for persons arch: who are actively engaged in a program to maintain or improve their health. Earnings 2,790 Annuities, 18.9 634 7.2 60% Age ?The oldest age gro Pensions up 330 of the elder Subscriptions to 9.2 ly, those age 1,014 EBRI85 Issue Bri and ov 11.1 eer, rec fs are included eive a 2,101great as part of er 15.5 percenta EBRI membership, or as part of ge o 4,263 f their tota 20.2 l income a who choose providers who are not identified as high-performing. GENDER/AGE: Men are Other much more likely than women 401 to think 2.7 that cost sharin 277 g should vary 3.1 with an individual’s level of 2.6% Rewar Orders/ ds Report and United States Findings. $49. Watson Wyatt Worldwide, 901 N. Glebe Rd., Arlington, VA 22203, — so that all decisions that relate to employee benefits, whether made in Congress or board rooms or 52.9% Old Age, Speci Implications fically, 62 percent of a Bear ag Market for reed with the statement t Retirement Sech uat rity pati htt ents ps://i actively partic nstitutional.vanguard. ipating in a com/iam/pdf/I health program shou CRRSBM.ld pay pdf $199 annual subscription to EBRI Notes and EBRI Issue Briefs. Individual copies are available Assets 1995 Data 948 26.5 3,265 35.6 3,111 23.0 3,449 16.3 The from Socia same patt l Security than those in t ern was found with respect t he youno ger annu age al grou earni ps n. In gs. Hi 20gh 07er-i , elder ncome ly pe worker rsons age 85 an s were more li d over derived 54.1 kely than lower-per- EBRI Congressional Testimony Survivors, engagement i families’ ho n their own m he es, are alth car based e. You on the highe nger individua st qualit ls are gen y, most depe erally more lik ndabl ely t e informatio han older in n. EBRI’s Web dividuals to sup site port posts (800) 388-9868 or (703 Total income ) 258-8000, fax: (703) 2 23,409 58-8585, ww 100.0 w.watsonwyatt.com 12,536 100.0 50% with prepayment for $25 each (for printed copies). Change of Address: EBRI, 1100 13th St. less than Earnings a patient not Old Age, activ 112 ely participatin 3.1 g in the same 116 type o 1.3f program, whereas 392 55 percent 2.9 of persons whose 1,409 6.7 self- and Disability Social Security 8,592 36.7 6,415 51.2 • Patients Subscriptions who choose less-invasive procedures to treat their medical condition should pay less out-of-pocket for income cent of th workers to supp eir income from S ort lower cost sharing for ocial Security, compared patients ac with 28.3 tively percpar entt for t icipatin hose a g in a ges 65–69 (Fi health progg ra ur m, patie e 5). You nts w nger ho use age all research findings, publications, an Assets, 4.4% d news alerts. EBRI also extends its education and public service lower cost sha Survivors, ring for those who comply with patient engagement rules. Testimony by Dallas Salisbury, EBRI, NW, Suite 878 before the, Se Washington, DC nate Special Commi , 20005-4051 ttee on , (202) 659-0670; f Aging, on “Boomer ax number, (202 Bust? Securi Insurance ) 775-6312; ng Stock Market Volatility Pensions and annuities Measures in Perspective 5,317 https://institutional.va 22.7 nguard.com/iam/pdf/ICRSM 1,766 14.1 V.pdf Other 314 8.8 361 3.9 282 2.1 576 2.7 reported health status was good agreed with the statement, and 47 percent of those in fair or poor health agreed with and Disability health care services than Assets patients who choo 3,467 se more-inva 14.8 sive procedures. 2,863 22.8 (OASDI) treatments th groups derive role to improving Ameri at have a greater s been ha scientifica re of theirlly c total an proven to s’ finan income cial kn be from effe owle ective arnin dge for gs from thro theiugh its a r medical co work. I w n ard 200 ndition, an -win 7, amon ning p d g thos ubli for patients ce el service derly who ages cam cpaign h65– oose 40% e-mail: subscriptions@ebri.org Membership Information: Inquiries regarding EBRI Source: Employee Benefit Research Institute tabulations of data from the Current Population Survey March 1976, 1986, 1996, and 2008 Supplements. Retirement in a Volatile Economy” www.ebri.org/pdf/publications/testimony/t157.pdf Insurance Earnings 5,452 23.3 1,251 10.0 17.2% ® 34.3% Earnings, the statement (Figure 2). Similarly, those in excellent or very good health are more likely than those in good, fair, or a membership and/or contributions to EBRI-ERF should be directed to EBRI President/ASEC ChoosetoSave Other and the companio 581 n site www.c 2.5hoosetosave.org 241 1.9 (OASDI) high 69, 39.9 -performi Includes public assistance, Supplemental Security Income, unemployment compensation, workers’ compensation, veterans’ benefits, perce ng nt of providers. their income was Similarly, t from here was work-r no elate patt d ern o earnin f support gs, com by a pared nnua with l ea 6.7 perc rnings ent o for lofwe th nonpension r cost sharin e income of g for Web Documents 1.8% Wellness Council of America Special Report: Financial Wellness: Thrifty Ideas for Turbulent Times RACE/ETHNICITY: Asians are across the board more likely than other race/ethnic groups to support the concept. Non- 2005 Data 88.7% Chairman Dallas Salisbury at the above address, (202) 659-0670; e-mail: salisbury@ebri.org poor h • Patients survivors’ benefits, nonpension disability benefits, educational assistance, child support, alimony, regular financial assistan ealth 30% to who agree t very care hat pa fully tients shoul follow their d have lo treatment re wer cost sh gime aring if ns should pay 1) they less out-of use providers i -pocket for ce from friends or relatives dentifie healt d as h high care -perf services orming, patients individuals who age 8 choose less-i 5 and over. Total income nvasive proc edures and 33,833 for those who 100.0 follow treatment r 17,383 egimens. 100.0 www.welcoa.org/freeresources/pdf/financial_wellness.pdf AARP: AAR not living in the individual’s household, and other sources of income. P Bulletin Survey on Retirement Savings: Executive Summary Hispanic blacks were least likely to support lower cost sharing, while Hispanics and non-Hispanic whites were in the Social Security 11,267 33.3 8,700 50.5 2) they than patients use less-invasive pr who do not ocedur follow es, an theid 3) they follow treatment r treatment regimens very carefull regimens. y. EBRI is supported by organizations from all industries and sectors that appreciate the value of 19.9% Pensions and annuities 7,235 21.4 2,844 16.4 EBRI Activity Other, 2.6% Editorial Board: Dallas L. Salisbury, publisher; Stephen Blakely, editor. Any views expressed in this publication and th Pensions and ose of the authors should http://assets.aarp.org/rgc 20% enter/econ/bulletin_retiresavings.pdf middle. Assets 4,252 12.6 Assets 2,630 15.1 unbiased, reliable information on employee benefits. Visit www.ebri.org/about/join/ for more. For the two younger age groups (65–69 and 70–74) earnings from work increased significantly as Annuities a source of income not be ascribed to the officers, trustees, members, or other sponsors of the Employee Benefit Research Institute, the EBRI Education and Wilshire Consulting: 2009 Wilshire Report on State Retirement Systems: Funding Levels and Asset Allocation Earnings 10,312 30.5 2,854 16.4 21.8% Fast Facts from EBRI 21.0% Whil Overall, e me 58 anin pegful rcent o diffferenc indivi eduals su s exist in pport opini lower ons by sel cost sha f-rep ring orted he for pati alth enstatus, dif ts who are act ferenices w vely participat ere not foun ing in d in o a progr pinions by am to Conc Resear lusio ch Fund, n or their staffs. Nothing herein is to be construed as an attempt to aid or hinder the adoption of any pending legislation, regulation, Other 768 2.3 355 2.0 8.6% from 1985 to 2007. For the youngest group (65–69 year olds) the increase was most significant, increasing 16.8 per- www.wilshi 10% re.com/BusinessUnits/Consulting/Investment/2009_State_Retirement_Funding_Report.pdf America’s Health Insurance Plans: Small Group Health Insurance in 2008: A Comprehensive Survey of Premiums, 2007 Data or interpretative rule, or as legal, accounting, actuarial, or other such professional advice. wheth maintain er a or im persprove th on has at eir lea health; 40 st one chperc ronic ent support lo health conditi wer cost on, or a sharing for chronic hea patients lth condiwho tion combine use treatd with ments that self-re ha po ve been rted This analysis finds support Total income for using lower cost sharing a 36,639 s a way 100.0 to engage pa 20,005 tients, but the suppo 100.0 rt varies with the centage points from 1985 to 2007 (calculated from figure 5). Among the two oldest age groups (80–84 and 85 and Product #117, Income of the Elderl March Choic 19, 20 es, and Be 09: Av nef erage Worker its y Population Age 65 and Over, 2007 www.ahipresearch.org/pdfs/smallgrou Contribution Rates to 401(k)-Type Plans: psurvey.pdf Social Security 12,083 33.0 9,268 46.3 health scientifica status lly 0%proven to of fair or poor. be effective However, for thei differenc r medical co es were ndition; 3 found by vari 4 percous personal ent support lo health wer cost shari behaviors. Obese ng for patients individuals who Worl type o datWork: f patient Trends i engagement Pensions and annuities n 401(k) Plans: being propos A S eu d. rvey of Fi 7,568 fty-ei Wo ght rl datWork perce 20.7 nt of Mem adb uers an lts with d Am 3,176 privat erican B e insura e 15.9 ne nce fits support Council Members lower cost over) EBR pensio I Notes n is and a register nnu ed in the U. ities have i S. Patent and T ncreaserd as a ademark Office. source I S of SN: incom 1085 -e. 445 Pe 2 1085 nsion an -4452/9 d a 0 $ . nnuities i 50+.50 ncreased from 9.2 percent www.ebri.org/pdf/FFE117.19March09.Final.pdf Old-Age, Survivors, and Source: EBRI estimates of the March 2008 Current Population Survey. Pensions and Annuities Income From Assets Earnings Other Assets 5,070 13.8 3,624 18.1 are gene choose to see IMPORTAN rally l CE e high OF SO ss likely th -performi CIAL SE anng non CURI health -obese TY: In 20 care individuals to a provi 07, So ders; 4 cial Sec 7 g re pe ue rity conti rcent suppo with the nue ab d to rt lower cost s ove stateme be the lar nts g hest source aring for about pati pat of ent e i income ents who choo ngageme for th nt an ose se d sharing both www.worldat for pati work.org/ ents wh waw/o are adimLiactively nk?id=318 partici 78 pating in a program to maintain or improve their health and for Disability Insurance Earnings 11,132 30.4 3,653 18.3 American of total incom Bene (in efits Cou 1975 ncil: ) for “Th individu e Savi als a ngs g fo e 8 r American 5 and over Families’ to 20.2 Fut perce uren Act of t in 20 2 07. 009 For ” [Summary individua] ls ages 80–84, pension th 1100 13 Street NW · Suite 878 Other 785 2.1 284 1.4 cost sharing. less invasive currently age procedur 65 a Similarly, nd older, es to t indiv accountin reat th iduals eir m who g smoke are for edical con 38.6 perce d less li itions nt of the kely ; and 5 than ir i 8n persons who perce come on nt support lo avera do ge. nw o Pension t smoke to a er cost shari and g n annuity ree wit g for patients h incom the various e was who patients who very care Source: Employee Benefit Research Institute tabulations of data from the Current Population Survey March 1976, 1986, 1996, fully follow treatment regimens. In both cases, about 14 percent oppose the use of lower cost #118, www.america April 2, 200 nben9: efits Worker councs’ Primary il.org/docum Reti ents/affa_pom rement Plan Type: eroy-summary www.ebri _111th.pdf .org/pdf/FFE1 18.2April09.Final.pdf Washington, DC 20005 Source: EBRI estimates of the March 2008 Current Population Survey. © 2009, Employee Benefit Research Institute -Education and Research Fund. All rights reserved. 2006, and 2008 Supplements. statements about lower cost 18.6 percent, income from a sharin ssets 15.6 g forper patients enga cent, and inco ged min t e from heir earn healith care. ngs was 2 With 5.3 respect to percent. exercise, there is no a (202) 659-0670 Includes public assistance, Supplemental Security Income, unemployment compensation, workers’ compensation, veterans' www.ebri.org benefits, nonpension survivors’ benefits, nonpension disability benefits, educational assistance, child support, alimony, regular financial assistance from friends or relatives not living in the individual’s household, and other sources of income. www.choosetosave.org ebri.org Notes • May 2009 • Vol. 30, No ebri.org Notes • May 2009 • Vol. 30, No ebri.org Notes • May 2009 • Vol. 30, No ebri.org Notes • May 2009 • Vol. 30, No ebri.org Notes • May 2009 • Vol. 30, No ebri.org Notes • May 2009 • Vol. 30, No...... 5 5 5 5 5 5 13 10 11 7 6 4 ebri.org ebri.org ebri.org A monthl ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org Notes • May 2009 • Vol. 30, No No No No No No No No No No No y ne tttttttttte e e e e e e e e essssssssss w • Ma • Ma • Ma • Ma • Ma • Ma • Ma • Ma • Ma • Ma sletter from y y y y y y y y y y 200 200 200 200 200 200 200 200 200 200 the EB 9 • Vol. 30, No 9 • Vol. 30, No 9 • Vol. 30, No 9 • Vol. 30, No 9 • Vol. 30, No 9 • Vol. 30, No 9 • Vol. 30, No 9 • Vol. 30, No 9 • Vol. 30, No 9 • Vol. 30, No RI Education and .......... 5 5 5 5 5 5 5 5 5 5 . 5 Research Fund © 2009 Employee Benefit Research Institute 14 17 16 18 12 15 5 8 2 9 3 Figure 4 Agreement With Statements About Proposed Ways to Engage Consumers in Managing Health Care Costs, by Work Status Variables, 2008 Figure 3 Figure 2 Agreement With Statements About Proposed Ways to Engage Consumers Patients who choose to see Agreement With Statements About Proposed Ways to Engage Consumers in Managing Health Care Costs, in Managing Health Care Costs, by Demographics, 2008 Patients should pay less for their medical providers that are Patients who very carefully by Health Status and Health Behavior, 2008 Patients who are actively treatments when the treatments identified as high- Patients who choose less- follow their treatment Patients should pay less for participating in a program to have been scientifically proven performing providers should invasive procedures to treat regimens should pay less their treatments when the maintain or improve their Patients should pay less for their to be effective for their medical pay less than patients who Patients who choose to see their medical condition should Patients who choose less- out-of-pocket for health care Patients who very carefully treatments have been Patients who choose to see Patients who choose less- Patients who very carefully Patients who are actively health should pay less than a treatments when the treatments condition, and pay more for choose providers who are medical providers that are pay less out-of-pocket than invasive procedures to treat services than patients who follow their treatment Patients who are actively scientifically proven to be medical providers that are invasive procedures to treat follow their treatment regimens participating in a program to patient with the same health have been scientifically proven to treatments that are proven to be identified as high-performing not identified as high- patients who choose more- their medical condition do not very carefully follow regimens should pay less out- participating in a program to effective for their medical identified as high-performing their medical condition should pay less out-of-pocket maintain or improve their issues who is not participating be effective for their medical less effective for their condition providers should pay less than performing providers invasive procedures should pay less out-of- their treatment regimens of-pocket for health care maintain or improve their condition, and pay more for providers should pay less than should pay less out-of- for health care services than health should pay less than a condition, and pay more for patients who choose providers pocket than patients who services than patients who Agree Disagree Neither Agree Disagree Neither Agree Disagree Neither Agree Disagree Neither Agree Disagree Neither health should pay less than a treatments that are proven to patients who choose providers pocket than patients who patients who do not very patient with the same health treatments that are proven to be who are not identified as high- choose more-invasive do not very carefully follow Total 58% 13% 28% 40% 24% 35% 34% 25% 40% 47% 18% 35% 58% 14% 28% patient with the same health be less effective for their who are not identified as high- choose more-invasive carefully follow their treatment issues who is not participating less effective for their condition performing providers procedures their treatment regimens Employment Status issues who is not participating condition performing providers procedures regimens Agree Disagree Neither Agree Disagree Neither Agree Disagree Neither Agree Disagree Neither Agree Disagree Neither Employed full time 57 13 30 39 24 38 33 24 44 46 19 35 57 14 29 Agree Disagree Neither Agree Disagree Neither Agree Disagree Neither Agree Disagree Neither Agree Disagree Neither Employed part time 60 13 27 34 32 34 30 26 44 49 22 30 60 13 27 Total 58% 13% 28% 40% 24% 35% 34% 25% 40% 47% 18% 35% 58% 14% 28% TotalNot employed, 58% 13% 28% 40% 24% 35% 34% 25% 40% 47% 18% 35% 58% 14% 28% Gender Self-Rated Health Status looking for work 77 12 11 68 17 15 63 14 22 66 12 23 77 10 14 Male 63 10 27 47 17 36 39 19 41 52 13 35 64 10 26 Homemaker 54 19 27 34 33 33 33 37 30 41 23 36 54 15 31 Excellent/very good 62 12 26 42 25 33 37 25 38 50 19 31 63 13 25 Female 53 18 28 33 32 36 29 31 40 42 25 34 53 17 30 Retired 59 16 24 40 22 38 32 24 43 47 18 35 56 16 28 Good 55 15 30 35 25 41 30 25 45 44 19 38 52 15 33 Age other 41 10 49 27 14 59 38 39 23 18 15 67 57 7 36 Fair/poor 47 18 34 43 22 35 34 28 38 38 24 39 51 18 31 18–24 61 10 29 48 20 32 45 27 28 56 11 34 63 8 29 Firm Size At least one chronic health condition* 25–34 57 11 32 38 26 37 30 26 44 39 20 42 55 12 32 Self-employed 54 17 29 35 17 48 25 28 47 45 21 34 65 7 27 Yes 58 15 27 40 24 36 34 27 39 47 20 33 59 13 27 35–44 57 17 26 39 23 38 33 25 42 43 20 37 57 14 29 2–9 55 15 30 31 36 33 24 32 44 52 20 27 51 22 27 No 58 13 29 39 25 36 35 23 43 46 19 36 57 14 29 45–54 54 15 31 38 28 34 31 23 46 49 21 30 55 16 28 10–49 54 16 30 35 25 41 28 26 46 48 22 30 61 14 25 Health Problem** 55–64 64 14 22 38 24 38 37 26 37 50 20 30 64 15 22 50–199 62 9 29 42 18 41 35 19 46 52 15 33 59 12 29 Yes 57 15 28 39 24 37 33 27 40 46 20 34 58 13 29 Race/Ethnicity 200 or more 60 12 28 41 25 34 35 23 42 47 20 33 60 13 27 No 59 13 28 40 26 35 35 23 42 47 18 35 58 14 27 White 59 15 25 39 26 35 34 26 40 47 21 33 59 14 27 Don't know 44 17 39 28 24 49 29 24 47 31 18 52 46 14 40 Obese Black 50 13 38 33 24 43 29 22 49 47 18 34 50 14 36 Annual Earnings Yes 50 18 32 38 25 37 33 30 37 40 22 38 53 17 30 Hispanic 55 11 34 41 20 39 40 21 39 46 14 41 55 13 32 Less than $20,000 51 20 29 27 38 35 28 28 45 51 16 33 55 15 30 No 61 12 26 40 25 36 35 24 42 49 18 33 60 13 28 Asian 65 9 26 47 19 34 42 22 36 52 13 35 65 9 26 $20,000–$29,999 55 13 32 37 22 41 29 23 49 42 22 36 53 16 31 Smokes Other 52 10 38 54 18 28 29 36 35 35 17 48 69 10 21 $30,000–$39,999 59 10 32 39 22 39 35 26 39 46 17 38 58 12 30 Yes 43 19 38 36 26 38 29 25 46 45 19 37 50 21 29 Education $40,000–$49,999 56 14 30 43 20 37 39 22 39 48 19 33 57 14 29 No 62 13 26 40 24 35 35 25 39 47 19 34 60 12 28 High school or less 53 14 34 40 25 35 37 23 41 49 16 35 56 13 31 $50,000–$69,999 58 12 30 41 25 34 34 25 41 48 20 32 59 16 26 Exercises Some college 56 15 28 37 24 39 33 25 42 44 18 38 55 16 29 $70,000–$99,999 64 11 24 41 22 37 32 21 47 51 19 30 66 8 26 Yes 59 14 27 38 25 37 33 25 41 46 19 35 59 14 28 College graduate 62 13 25 40 25 35 32 28 40 48 19 32 61 12 27 $100,000–$149,999 61 15 25 38 27 35 32 28 39 45 23 32 58 14 27 No 55 15 29 44 25 31 37 25 38 49 19 32 56 15 29 Graduate degree 66 14 20 42 26 32 35 26 39 43 27 30 65 13 22 $150,000 or more 61 18 21 45 25 30 42 22 36 49 20 32 63 14 22 Source: 2008 EBRI/MGA Consumer Engagement in Health Care Survey. Household Income Don't know 50 13 37 30 23 47 22 20 58 34 19 47 49 11 40 * Arthritis; asthma, emphysema or lung disease; cancer; depression; diabetes; heart attack or other heart disease; high cholesterol; or hypertension, high blood pressure, or stroke. < $50,000 55 15 30 40 23 37 39 25 37 48 16 36 57 14 28 Source of Health Coverage ** Health problem defined as fair or poor health or one of eight chronic health conditions. $50,000 or more 60 13 27 40 26 34 32 26 42 47 21 33 59 14 28 Own employer 58 13 29 40 23 37 34 23 43 47 17 36 59 13 28 Don't know 57 15 28 34 21 45 30 22 49 41 22 37 56 13 31 Other employer 54 15 31 32 30 38 28 25 47 43 25 32 53 15 32 Source: 2008 EBRI/MGA Consumer Engagement in Health Care Survey. Direct purchase 60 14 27 43 24 33 36 31 33 53 20 27 63 16 22 Don't know 36 16 49 34 17 49 23 27 49 37 16 47 47 30 23 Source: 2008 EBRI/MGA Consumer Engagement in Health Care Survey.