Enrollment in consumer-directed or high-deductible health plans eligible for a tax-preferred savings account increased to 9.8 million adults this year, with participants more likely to have higher incomes and be in better health than those with traditional health coverage, according to survey results released by the nonpartisan Employee Benefit Research Institute (EBRI).

• Fourth annual survey: This Issue Brief presents findings from the 2008 EBRI Consumer Engagement in Health Care Survey, which provides nationally representative data regarding the growth of account-based health plans and high-deductible health plans (HDHPs) and the impact of these plans and consumer engagement more generally on the behavior and attitudes of adults with private health insurance coverage. Findings are compared with the 2005, 2006, and 2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys.

• Enrollment low but growing: In 2008, 3 percent of the population was enrolled in a consumer-driven health plan (CDHP), up from 2 percent in 2007 and 1 percent in 2006. Enrollment in HDHPs remained at 11 percent. Overall, 9.8 million adults ages 21–64 with private insurance (representing 6.6 percent of that market) were in either a CDHP or an HDHP that was eligible for an HSA, but had not opened the account.

• Higher income, better health: As before, this year’s survey found that adults in CDHPs were significantly more likely than those with traditional health coverage to have high household income, to be in better health, and to exhibit healthy behavior.

• Satisfaction gaps: CDHP enrollees in 2008 continue to have no difference in satisfaction with quality of care compared with those in traditional plans, but a satisfaction gap remains for HDHP enrollees. Differences in overall satisfaction levels (higher satisfaction with traditional plans) were reinforced in the 2008 findings.

• Choice of plan: Among individuals with employment-based health benefits, those in CDHPs were more likely than those with traditional coverage to have a choice of health plan. This contrasts with findings from 2005 and 2006, when individuals with traditional coverage were more likely to have a choice of health plan than individuals enrolled in CDHPs. Two-thirds of individuals with an employment-based CDHP reported that the employer contributed to the account. Among those eligible to contribute to an account, 15 percent contributed nothing.

• Cost-related access issues: In 2008, HDHP enrollees continued to be more likely than traditional plan enrollees to report that they had delayed or avoided getting any needed health care services because of costs. But the difference between traditional plan enrollees and CDHP disappeared, mostly because more traditional plan enrollees reported access issues due to costs.

• More cost-conscious behavior: Individuals in CDHPs and HDHPs exhibit more cost-conscious behavior in their health care decision making than individuals with traditional health insurance. • Strong interest in reduced cost sharing: There was across-the-board strong interest in consumer engagements that could lower patient cost sharing, such as select networks (medical providers with records of high quality care), health promotion programs, and using scientifically proven effective care.

choose from 2005 onl that are below current thresholds that would q Figure 19, Percentage of Individuals With Traditional y significant increas represents 13.4 m . In 1 in In addition, over the four Individuals in CDHPs and 5 ad 200 Yes protect them am 8, 40 ults in CDHPs used an onli ong different health care providers, percent of those in C illion people. Am e in the percentage of traditional pl in the event of an expensive illness. years of the survey HDHPs ong the 13.4 m DHPs had incomes of $100 ne cost-track exhibit m uality C , people o for HSA tax preference, and the re cost DHP and HDHP are ing to illion individuals with an HDHP, 42 percent, or Em an enrollees reporting access issue ploy ol, their -enrolled in C The percentage of individuals agreeing with these conscious behavior in their health care ment-Based H ,000 reported use is about twice the rate or m DHPs became significantly m still less likely ealth ore, up from Benefits Off y do tha no 22 p st have an HRA- due to costs (Figure n traditional e ercent in 200 red decision- 5.6 ore 5. Paul Fronstin is director of the Health R Kaiser Family Foundation/Health Research and Educational Trust Health Reimbursement Arrange esearch and Education Progra Figure 5 m ments at EBRI. This (KFF/HRET) Issue Brief was Figure 12 Health P Contribu Enrollment in CDHPs and HDHPs Endnotes Figures ltion Beh an Features and Demogr avior and Accoun aphics t Balances Figure 19 Figure 32 Figure 15 Figure 10 Figure 21 Figure 17 Figure 25 Figure 36 Figure 23 Figure 8 Figure 3 Figure 1 Figure 27 reported by enrollees to report that their plan pr In contrast, there was little change in the based plan. 29). No signi likely making than individuals with traditional million, repor HDHP or CDHP, 2008 to No statements in 2008 people in HDHPs or traditional plans. Othe be em ficant access ted that the ployed in la y rge fir were eligible was issues were f ··········································································································· unchanged from ovides this information. Three-quarters of CDHP enrollee ms and less likely income dist ound between for an HSA health insuran 2007 ribution of people enrolled i to rwise, ther but did CDHP enrollees and traditional plan enr be sole proprietors or e levels. ce. Adults in CDHPs and HDHPs not e were no differences in cost-conscious have such an account. m n traditional ployees of s Thus, were s plans: 23 per- m and 72 perc al overall, 9.8 m l com o24 llees during o rep likely anie ent s. to In 2008, KFF/HRET conducted a nationally representative survey of nearly 2,000 employers of all sizes. written with assistance from Percentage Extremely or Very Likely to Stay With Current Health Plan If the Institut Annual Deductibles and Premiums, e’s research and editorial staffs. Any views expressed in this report 1 Health Savings 1 Accounts Among individuals with a CDHP, some receive employer contributions to the account while others do Percentage of Adults Who Agree That Terms of Coverage Make Them Premium Increases Among Employers With 10 or More Employees, Likelihood of Changing to Select Network if Current Doctor Percentage Extremely or Very Satisfied With Out-of-Pocket Percentage Extremely or Very Satisfied With Quality of Number of Years Covered by Current Health Plan, Premium of Selected Plan Compared With Other Annual Individual Contributions to the Account, Annual Employer Contributions to the Account, Percentage of Individuals With Traditional Employment-Based Figure 1, Pre According to The majority m of privatel the 2008 EBRI Consumer Engagement ium Increases Am Length of Time With CDHP y insured adults ong Employ have deductib ers With 10 and Savings Account, 2008 in Health Care Survey, 9.8 les, or More regardless of plan t Employees, ype. More than 3 in 5 Worker Earnings million adults ages 21– Amount Rolled Over from Past Year, 2008 Percentage of Individuals Covered by Employment-Based Health Benefits of indi decision making across plan t cent had hous In 2005, nearly half (47 2008 consider costs in their decisions about h million adults Because the base sam viduals , except am Not sure ehold incom in traditional plans reported that their ages 21–64 ong higher p ele (n s of $10 percent) of CDH y with private insurance (representi -pes when income indiv ational sam 0,000it cam or m by Type of Health Plan, 200 p ealth care. lP enrollees w iduals, but H e) included oe re in 2008, com to talk heThose in CDHPs and HDHPs we alth plan would protect the ing t onl DHP en ere sole proprietors or worked in com o y doct 79 indivi ng 7.9 pared with 21 rollees were found to be m ors about treatment options percent of that market) wer 8 duals in a CDHP and 215 percent in 200 m in the even re m5. o ore likely re likel and costs, t of an pa ie ndividuals n either in a ies of fewer y t than t han those hose are those of the author and should The 2008 survey A health reim • Among individuals with em bursement found tha ar t 5.5 m rangement (HRA) i not illion be ascribed to th ploy workers enrolled ment-b s an employer-fund ased health be e officers, trustees, or other sponsors of EBRI, EBRI- in either an HRA (2.2 nefits, those in CDHPs were ed health plan that reimbu million) or an HSA-based mrses ore likely than Had the Opportunity to Change, by Type of Health Plan, 2005–2008 1 1 1 2 3 not. HRA enrollees will get em Consider Cost When Deciding to Seek Health Care Services, 2008 Available Plans, Among Individuals With Choice of Plans and Health Care Received, by Type of Health Plan, 2005–2008 Health Care Costs, by Type of Health Plan, 2005–2008 Worker Earnings Increases and Inflation, 1988–2007 Was Not in Select Network, by Type of Plan, 2008 ployer contributions by Type of Health Plan, 2008 but are unable to make their own contribution. More information about HR by Household Income, Among Persons With CDHP, As and HSAAmong Persons With CDHP, s can be found in the boxes on pgs. 13– 200814 and in 2008 Fronstin (2002 and 2004). (62 percent) of adults enro 64 with private health insurance wer Increases, and Inflation, lled in traditi Health Benefits Offered HDHP 1988–2007 e en onal plans re rolled in eithe ························································································ ported that th r a CDHP (a or CDHP, eyplan with an had a dedu 2008 ctible. Am HSA or HRA ong adults with ) or an HDHP 6 1 2 3 With Choice and No Choice of Health Plan, by Type of Health Plan, 2008 EBRI Issue Brief expensive illness, co asking a doctor to recommend a less cos with a HDHP Figure 20, employees for qualified medical expen than 50 em with traditional coverage to report access issues, espe in traditional CDHP or wer In addition, w Percentage of Individuals Wit those with traditional coverage to have a choice of , an oversa ploy plans to ask their doctor to reco eo in an HDHP that was eli ees. By rkers in both CDHPs and mpar med with 67 per ple of individuals with a CD 2008, that perce ses. HRA cent am tly prescription h Em g nible for an H tage had falle HDHPs plong individuals enrolled in HDHPs. s oy mmend a are er Contributi were ty HP or HDHP pically comb drug, checking the quality cially SA, but had less costly n to one-third (32 mo health plan. r am eon to likely ong those with a health problem and those ined with a hi was added. The oversa prescription drug. There wa Account, Am not opened t than those in traditional pla These results ar percent). Em gh-deductible health plan hong rating of a hospital or e account. (See section on Persons ploy e m in contrast to ple included m With ent of CDHP s no change in ns to be , ERF, or their plan (3.2 m 70% 25% staffs. Neither EBRI nor E illion) (up from 3.8 million i BRI-ERF lobbies or takes positions on s n 2007, an Traditional d 2.7 million in HDHP 2006). The p CDHP ecific policy proposals. KFF/HRET survey does not 75% A health savings account (HSA) is a tax-exempt trust or custodial account that an individual can use Individuals with an HSA can contribute 80% Those in the Individual Market, by Type of Health Plan, 2008 (Percentage of privately insured adults ages 21–64) their own m Figure 34 oney to the account and may or may not also receive 45% that was eligi single-person coverage in traditional pla ble to contribute to an HSA (up from 76% ns, 38 percen 3.9 t had no million in 2006). T deductible, 33 his represents 7.9 percent of adults percent had a deductible below 50% 64% 45% 75% Total Sample 1,634 74% 1,714 1,184 doctor, or che sole proprieto 1,102 individuals with a CDHP and 1,419 individuals although this enrollees in com the share of CDHP enrollee with househo enrollment starting on While there has been very While panel Internet survey Employ is not requir c rs or to be emplo king the pric m ld incom ent-Based Health panies of 500 63%e ed. HRA pg. of $50, e of a health care s 38 for m l y sittle significant change ove who reported cost-conscious ed i or m 000 ss are no Benefits and CDHP, 2008 n c small firm ao o n or ab re inform re also be worker nrandom ove. ervice b s. offere ation about s cli Ho , studi m wever, over the four e with a HDH d on a s fore getting bed from es r time to the health plan vi have dem other research that has esti decision ·························································· tand 36 percent to 42 P, resulting in a total sa -care. alone b onstrated that such surve making over t y aears of the surve sis or with compre percent. h ew questions, there was e four mat m ed the size of the p y yle (base plus ears of the surve , workers hensive ys, wh 24 en y, 2 Introduction include nonworking adults 20% 75% findings from 2005 and 2 or childre 73%006, when in n in its esti di m viduals with ates. It also does traditional coverage were not include federal emore likel mployees or worker y to have a s EBRI invites co mment on this research. 46% 46% Figure 30 Less Than $200 to pay 100%for he Trends in Cost-Conscious Decision Making, by Type of Health Plan, 2005–2008 alth care expenses. Contr 61% ibutio 41% ns to the account are deductible from ta 71%^ xable 71% income, e See mploy www.m er contributions. Two-thirds of individuals ercer.com/referencecontent.htm?idContent=1287790 with an em 2005 2006 ployment-based C 2007 2008DHP (including both those 45% 70% 60% 45% 41% 75% Single Person Deductible ages 21–64 w $500 Figure 2, Dist , 16 percent had a ded ith private ins ribution of In u uctible be rance (up from dividuals Co Issue Brief tween $500 vered b 6.6 percent in and y Priv $999 ate He 2 , and 1 007) alth Insurance, by . 3 The EBRI survey percent either did n Type of Health Plan, does not ot know in if the clude childr y had a en 2005 2006 2007 2008 12 3% 3 a nearly enrolled in CDHPs bec oversam insuranc but there was a significant increas carefully CDHP and/or HDHP 45% The survey noted an across-the-boa across-the-board in e that does n ple) designed, o of 1,184 for ot u ab m t market.) tain r sh e significantly m e a high dedu e CDHP group and crease between 20 esults co e in the percentage m ctible. Empl Don't Know parable to ra rd increas ore likely 06 and 1,634 e in the percentage of oyees to be for the HDHP grou 2 ndo 007 i of traditional plan enrollees reporting cost-conscious m-digit-dial t em are eligi n the per ployed in large firms. Those in CDHPs w 2005 ble for an H centage of CDHP enrollees who elephone surv 2006 p. Aft the pop e Rr factoring o A only when t 2007 ulatio eys. Ta n reportin 2008u yt of the lh or ( eir employer g th 2003), base at they e for re in firm 60% 70% s choice of health plan than individuals enrolled in with fewer than three employees. More information can be found at CDHPs. Two-thirds of individuals with an Availability and Use of Quality and Cost Information even for indi 40% viduals who No deductible do not itemiz Traditionale their HDHP taxes, 38% and CDHP tax-free N/A distribution N/A s for qualified medical 40% EmploymeBase: Adults ages 21–64 who received some health care in last 12 months nt-based health benefits are t Less Than One Year he m 1–2 Years ost common for 3–4 Years m of health insurance in the United States. 5 Years or More covered as an individual and those with family coverage) reported that the employer contributed to the Don't Know if CDHP or 63%* in the surve deductible or 2005–2008 y. Any did no childre t kn······················································································································ ow n enrolled in what their deductible was CDHP 11% or HDHP plans eligible for an HSA are (Figure 5). A $200–$499 mong adults with fam not ily in coverage in cluded in the ········· 6 9.8 Strongly Agree 63%* 12 63% 63%* 3 3 Premium Increase Figure 29 offers such a health plan. 1 2 3 20% reported that: m sam Figure 21, or decision making. exam were in excel p e likely le the 79 indivi HRA and HS ple, provides the results from Annual Em em than those with traditional c ploy lent or ver mduals A enrollment is growing, ent- ploy $1–$499 based CDHP with a CDHP er Contribut y good health—but, interestingl reported that a num ions to and the 215 i overage to ha be tbut the m h r of survey e Account, Am the em ndividuals with a HDHP, there are 1,714 indi ve 33 aa choice of health plan. rket s ploy yt,h no change in the percentage with at least one at were conducted at t penetration remains relativ er ong Persons With CDHP, 2008 contributed t N/A o the account. These results N/A he same tim ely sm Am are in contrast ······ all, and the plans e ong persons using the same viduals 26 in Trends http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.6.w492 61%* . 1 2 3 See www.healthcaredisclosure.org/ Provided by Health Plan and Effort to Find Information . HDHP Was Offered Traditional HDHP CDHP In 2007, 162.5 m expenses are 40% not counted illion Traditional individuals under age 65, or in taxable HDHP income. Tax CDHP 62.2 percent of that population, had em -free distributi No. 323 9%ons are also allowed for ploy cem rtain ent-based account, while 30 percent reported that they did 35% Traditional not receive employer contributio HDHP ns, and 4 percent did n CDHP ot 20% traditional pla million adults with private ns, 44 percent had no health insurance. Th deductible, 34 e 2008 enrollm percent reported t ent num hat the deduc ber is comtible was below $999, parable to estimates 34% 60% $500–$999Access Issues, by Type of Health Plan, 2005–200 57%* 16 N/A 8 N/A Employers have a tremendous amount of flexibility in designing health plans that incorporate an HRA. to findi the sam questionnaires both via tele are still relatively new and E chronic condi BR35% I E 35% ngs fr The survey fo pm le wi ploye om th traditional e B 2005 and ene tion, with a fit R und across-the-board stron esear2006, when i chealth coverage. h I health problem, who were ob nunknown phone and stitute Issue B ndividuals with to on rief many line. He foun (ISSg N individuals with privat interest 0887 -13traditional coverage 7 in select network Xd ese, or in the num ) is that the use published mont e insurance. Am of dem hly 32% s by co ber of were the E ographic weighting mposed of onl m m workers, and no increase in ploy ore likely ee B ong persons with enefit y R to have a m ese ear dical alone was ch Institute, There has bee • 50% Their health plan was easy eligible to co n no increase ntribute to in the share of C to understand an account, 15 p Total10 DHP enrollees who report cost-consci (increasing from ercent did not <$50,000 contribute an 45 perc $50,000+ 56% ent to 53 percent). ything. ous decision making 2005 2006 2007 2008 2005 2006 2007 2008 2005 2006 2007 2008 Somewhat Agree From Other Sources, 2008 Worker Earnings Increases 15% 46%* This survey health benefits (Fronstin, 2 premiums. Availability and Use of Cost was made possible with support from Not Offered a 008). and Quality Information American Express, Blue Cross Blue Shield Association, know if the employer contributed (Figure 20). 45%*^ 45%* $1,000–$1,999 N/A 1 58% 2 49% 3 1100 13th St. NW, Suite 878, Washington, DC, 20005-4051, at $300 per year or is included as part of a membership subscription. Periodi- 4 12 percent reported that it published Figure 3, Num 35% by other sources. A summa ber of Years Covered by was between ry$1,0 of the other s Current H 00 and 52%*$1 ealth Plan, by T ources is below. ,999, and 10 percent either did n ype of Health Plan, 2008 ot know·············· if they had 8 For ex Total Sample ample, the amount of money that is placed in 953 1,363 th 1,794 Traditional e accou 417 1,548 nt, the level of the 8021,284 HDHP1,484 deductible, and the 163652805 CDHP 1,077 November 2008 1 2 3 choice of health plan t Figure 22, providers with records of high qualit sufficient to bring alm CDHPs, 37 percent had been covered by their health the percentage reporting that they In addition to being stratified, the base sam 75% Annual Emh ploy an i o CDHP or HDHP st al er Contribut ndivid l of the results fro uals enrolled in CDHPs. Two-thirds of indi exercise regularly ions to y care when co th pe Account, Am le was m the online survey close to th mbined with lower cost . al pl so weighted by gender, age an three ong Persons With CDHP, 2008 years or longer i vi shari e replies fro duals with an n ng. There wa , 20 education, region, 08 (Fig m the parallel em ······ ur ploy e 3), up fr s less intere 26 ment-om st over the four See •Ap 50% •pe The plan encourages adopt ndi There was no x yfo ears of the s r more det significant variation acros au ilrve on t yh (Figure e m ion of a ethod 34). There was a signific olhealthier lifesty ogy. s plan ty le pes i (increasing from n the frequen ant increase i c 52 percen yn with whic the percentage of t to 63 percent). h people with chronic Mercer $2,000–$4,999 N/A Traditional 29 HDHP 50%* 40CDHP Hewitt Associates, IBM, John Deere & cals pHSAs are owned by ostage rate paid in Washingto the i n, Dn C,dividual wi and addi Co., Kaiser tional m th the ailingPerm ohig fficeh-d sanente, Pfizer, Proctor & Gam . Pe Od S 49%* T ucti MAS ble heal TER: Send th pl addran ess c and 69%* hange are complete b s t le, and The o: EBRI Issue Br ly portable. ief, 1100 In every year since 1998, health insurance premium increases have exceeded worker earnings increases Among the 66 percent with an employer contribution, 12 percent received less than $500, 26 percent Checked whether health plan would cover care 30% 50% 51% 2005 Overall Inflation 58% 2006 50%^ 2007 55%^ 2008 61% 2005 62% 2006 61%* 2007 61% 2008 60%* 2005 62% 2006 60%* 2007 63%* 2008 16% one or what it 50% 30% In theor was. y, the incentives of CDHPs 28% are designed to promote heightened sensitivity to cost and quality in comprehen 50% siveness of the health in 47%*surance are all subject to variation. Empl 38%*^ oyers often cover certain based CDHP income and race/ethnicity in actually changing t telephone survey 21 percent in 40% reported that 2006 (data not shown). A . He also found $5,000 or hi o a select network co to reflect the actual proport the em gher ploy that in er contributed t m so ong traditiona m me b case ined with o is propensit ons in t the account. N/A lower cost sharing. T l plan and he population age y weig Am HDHP enroll 8 hting (m ong persons eligible to 21–64 with private health eaning the pro here was ees, 59 percent and 55 per- 8 also support (t pcontribute to ensity for a o a 13th S 30% t. NW, Suite 878, Washington, DC, 20005-4051. Copyright 2008 by Employee Benefit Research Institute. All rights reserved. No. 323. traditional pla conditions fol n enrollees reporting cost-conscious deci Health plan provides information on quality of care lowed their treatment regimens. This sion making, which would is in contrast to somewhat explain why mixed findi some of the ngs in • 50% Mercer, a human resources and benefits consulting fi The plan provides information to help choose among pr rm, conducts an annual sur oviders (increasing fro 36%* m v 56 percent to ey of employers with at Total Sample Asked for generic drug instead of brand name drug — 48 46 50^ — 60* 58* 58* — 54 54* 58* Comm and inflation There is no onwealth Fun use-it-or-lose (Figure 1): H d. -it rule ealth insurance prem associated wi iu th HS ms hAs, as any m ave more than do oney left i ubled, w n h the acco ile worker earnings have unt at the end of received between $500 and $999, 22 40%percent received between $1,000 and $1,499, 11 percent received $500–$749 5 1,061 1,506 61%* 1,918 1,714 463 930 1,404 1,634 185 722 895 1,184 11 $2,000 or More 34%*^ 25% Figure 4, Fa people’s deci Among adult miliarity sions about t s with single-person c Family Deductible Withh Consum eir health er-Driven Healt overage and enroll care. Yet the abilit h Plans, 2008 ed in a HDHP, y of people ······················································· to m 58 apercent reported a deductible of ke informed decisions is highl 8 y America preventive services in full, ’s Health Insurance Plans not subjecting (AHIP) them to the deductible. Employers can offer comprehensive health provided by doctors 34% 25%* 38%* 27%* Traditi15% onal plans include a broad range of plan types, including health maintenance organizations (HMOs), preferred an account, 1 insurance coverage. Figure 23, degree) regar certain ty cent, respectively, had Talked to doctor about treatment Annual In pe of person to be 5 percent did ding divid The other way u been covered b not contri al Contribut CDHP and HDHP oversam online) reduc s patients could receive lower bute ions to t anythin y their health pl ed the re he Acc g. mount, b a ples were in an three y ing gaps, y cost shari Ho weighted b usehold Inco ears or lon but ng, such as by actively in other cases yg gender, age, inc er in me, Am 2008 it did ong Persons . With r not reduce the o participating in a me, and espect to previous significant differences in cost-conscious decision making between those covered by 24%*^ traditional least 10 em 25% 2007. Furt ployees. Nearl hermore, the 2007 surve y 3,000 employers were su y found that a rveydul ed i ts with CDHPs and HDHPs n 2007. In 2007, 17% Mercer found that 5 percent were significantly Total 61 percent). 18%24% 31%* 25% 40% 23%* increased only 30 the year automatically ro 25% percent (calculated fro lls over and ism available in the Figure 1). In 30%* response, em following year. ployers have been seeking ways to between $1,500 and $1,999, and 18 per No deductible cent received $2,000 or m 44 ore (Figur N/A e 21). Em N/A ploy 41%*er contributions 10% 22%The Em 35% ployee Benefit Research Institute (EB 22%RI) was founded in 1978. Its mission is to between $1,0 insuranc dependent on the extent to options and costs e that cover 00 and Health plan provides information on cost of care s $1,9 100 99 percent of health car , 29 which the percent had deductibl y have acc e costs ess to es between $2,00 after the deductible has useful information. 0, and $4been met or ,999, and 8 pthey may offer ercent had pr ovFindings From the 2008 EBRI Consumer Engagement in In 200 ider organ 8, AHIP conducted izations (PPO 50% s), ota census of health plans to her managed ca 42 re pl 44 ans a44 nd pl determ a45 ns witine the num h 56* a broa 44d vari 49*^ ber of people enrolled ety of 49 cost-sha 58* rin 46^ g arra 47 nin plans gement 46 s. 37% 30% 21% race/ethnicity program rem fam Consistent with these trends, peopl iliarity aWith CDHP, 2008 ining gaps. Perhaps the m to , using t with a CDHP, 59 percent of t maintain or improve health, he dem ················································································································ ographic pr ost striking differen e in CDHPs continued to be m ofile of the by hose with a CDHP were ex follow C ing DHP and HDHP respondents to the om ce in dem treatment regimens, by ographics between telephone and 32% ore trem satisfied wit ely or ve choosing less invasive ry h fam their plans in 2008 iliar wi nibus surve ·· th a CDHP online surve 27 y ys plans and CDHP enrollees Not filled a prescription due to cost (you or family more likely to report that t disappeared between 2007 32% hey had avoided, skippe and 2008. d, or delayed health care beca 20%* use of costs than of workers with health insurance wer $1–$999 e covered by eith 34 er an HRA or HSA (up fro N/A N/A m 3 percent in 2006). The • The plan will protect them in the event of an expensive illness (increasing from 69 percent to 76 per- In order for an individual to qualify for tax-free contributions to an HSA, the in 37% dividual must be manage the cost increases. In recent y Satisfaction and Attitudes Asked doctor to recommend provided by doctors contribute to e, to encourag a 34% rs, employ 30% e, an ers turned their a 30% d to enhanc 26e the developmen ttention to 19* account-based health plans—a 34%* t of sound empl 20* o12% yee benefit vary, however, by whether an individual has employee-only or family coverage. Individuals with employee- 50% 19% coverage 20%with cost sharing after the deductible is met. 18%* If employers choose to pay less th 18%* an 100 percent of Th deductibles of $5,000 or more. Eight e sh Figure 5, Annual Deductibles and Premiu ared ch The surve aracteristic of this g y asked about th roup is th e provision y percent of those in HDHPs at they eith m of s, by info er h T rm aype of Health Plan, 2008 veation in separate questions. One question asked no deductible o with fa r dem du ily ctib coverage ha ···································· les that are below cu d a deductible of rrent 11 with an HSA or eligible for members) 20% one. AHIP determined that 16% 16% 6.1 m 17% illion 15% people were in an HSA-eligible plan i 26%* 21%* 21%* 21%* 21% 23%* 19%^ n 17 $1,000–$1,999 27% 12 19% 17%*N/A N/A than the described below. procedures, and by using scientifically was the underrepresentatio (Figure 4). I 30% y were in 2006. In n contrast, only 8 percent of indivi 2006 indi n of mviduals in CDHP inorities in onli proven effective care. dua ne sam s and HDHPs were less likely ls 27% with traditional coverage ples. were extremely than those in traditional or very 11% less costly prescription drug 20% were those with more tradit CHECK ional coverage. OUT 25% In 2008, the survey EBRI’S found that HDHP enrollees W 26%* EB SITE! Mercer study does not include nonwor programs and so 17% ki 27 ng adults, chi und public policy 31 30 ldren 36^ 16%* through objective , or pers 46* 41* ons who get c 43* research and 41 overage in th educati 45* 39* on. EBR e individ 38*I is the only 36 ual cent) (Figure 14). Of those whose plans provide info on quality, how co covered by a mbination of health plans with deductibles of at l health plan that has an annual dedu east $1,000 for ctible of not leess tha mployn ee-only c $1,100 overage and tax-preferred for self-only coverage only Health Care Survey coverage are most likely to get an employer contribution between $500 and $750, while those with 24% th health c resh Skipped doses to make medication last longer (of those olda sre e that xwou penses ld quafter ality fo $2,000–$4,999 the deductibl r a tax-preferred e has be HSA c en m ontrib eN/A t, th ution ey then or that are g have the 80 enerally opti asso on of de 70 ciatedsigning the plan with HRAs. between $2,0 respondents i Respondents were asked a series of questions regard 00 and C f they agreed or disagreed with a very itat$4,9 ion: Paul 99, and 1 Fronst 5i per n, “Fi cent were in ndings Froma plan with a d th g e 20 eneral statement about inf 0ing their attitudes toward their health plan 8 EBRI C eductible of $ onsumer Enga 5,00 g oe rm m 0e ation. Specifically or h nt inigh er. and , the January 25% 2008 (up from 4.5 million in 2007 and 3.2 million in 2006) 23% . Nearly 4.6 million had coverage Checked price of service before getting care 20% 25% 24 20 21 23 35* 23^ 27*^ 23^# 29 26* 27* 25 plans to be satisfied with qualit Figure 24, fam To efficiently identif 15% iliar with The 2008 EBRI Consumer Annual In a CDHP, and only divid yu respondents who al Contribut y of care received, Engagement in Health Ca 10 per ions to t cent of individuals with an HDHP wer would qu h 13%* e Account, but between 2006 and 2007, alify for the CDHP and HDHP oversam b re y Survey suggests that Type of Coverage, Am the e gap in satisfaction exthe face of enrollees in trem ong Persons ely or ve ples, ry this fam iliar many tried to use it for doctors private, nonprofit, nonpartisan, Washington, DC-b 60 ased organi 48* zation com 56 mitted exclusively to market. The survey continued to also be m does not incl ore likely than traditional plan en ude firms with fewer than 10 e rollees to report that the mployees. y had dela 21% yed or avoided who were given a prescription) (you or family members) 10% $5,000 or hi 21% gher N/A 15 28 savings or spending accounts that workers and their fa and W 15% $2,ho we are 200 for family cov 9% erage. (Minimum ded 15 16 uctible amoun m 9% 16 ilies 15 can use to pay their out-of-pocket health care ts 25* are increasin 22* 22* g to 22* $1, 20 150 23* and $2, 17^ 300 i 16 n family coverage are most likely to get an employer contribution of at least $1,000 (Figure 22). In fact, with or with out a maximum out- 19% of-pocket limit. Checked quality rating of doctor/hospital Health Care Survey,” EBRI Issu 18 e Brief, 21 no 20. 3225^ 3 (Novem 22 ber18 2008). 19 22 18 19 18 23^ Figure 6, Percentage of A respondent was asked if he or she agreed with: “My satisfaction with regard to Am 20% ong CDHP enrollees with single-per dults Who various aspects of thei se Deductibles Apply son coverage, 18% r health care. Questions were asked about o health plan pro 49 percent had a deductible to All Medical Serv v16% ides inform 16% ices, by ation to below $2,000; 40 per- Coverage 16% help m vee rall choose through the e 25% 15% mploym Of those whose plans provide info on cost, how many ent-based market, while an additional 1.5 million had it through the individual market. 5% public policy research and education on economic security and employee benefit issues. 24% between those in traditiona analy consumer-driven health plans is c with a CDHP sis used With CDHP, 2008 Synovate . Premium (Family) ’s om l plans and those with ················································································································ nibus survey of m ontinuing to change. On average, ore th CDan 87, HPs disappea 000 onlired because s ne panel mem enrollees in CDHPs atisfaction increas bers who met the criteria are significantly ·· ed 27 for 6 getting any 11% needed health care services 8% 8% because of costs; however, the difference between traditional 16%* Not filled a prescription due to cost or skipped doses to The survey also found that 7 percent of employers with fewer than 500 employees offered either an HRA The percentage of indi 15% viduals agreeing with these statements in 2008 was unchanged from 2007 levels 200 Participated in wellness program 10% 25% 9.) Certain preventive services can be covered in full and are not subject to 12% the deductible. The 59 percent of Acc expenses. Em ording to dat individuals with fam a f ploy romers first started offering account-based the Kaiser Fam ilyi coverage get a contribut ly Foundation/Health Researc health plans in 2001, ion hof at least $1,000, and Educational Tr when a handful of em ust with 25 percent getting annual employer sur ploy veye , rs Cost-Sharing Incentives By Paul Fronstin, EBRI There is no statut tried to use it for doctors ory requirement that an employee have a high 49-deductible healt 40 h plan in orde 52 r to also cent had dedu am satisfa ong ph ction with the health Source, 2008 yctibles between $2,0 sicians, pharmacies, labs, and 10% ··················································································································· plan as well a 00 and $4,s hospitals.” The kind 999 satisf , and ac tion related to quality 8 percent had deductibles of informati of on pro care received, out-of-pocket of $5, vided was not 000 or more. Am ······· defined. As 11 ong 9% EBRI’s member EBRI’s ship includes a Web site is easy to use and pac cross-section of pension funds; businesses; trade associations; 7% ked The report di 10% d not count H NoneRA enrollees, but it does include 14 workers, nonworki 9 ng adults, and 8* 20% children. There make medication last longer 22 22 23 21 32 29* 29* 31* 30 9%* 31* 24^ 23 significantl the stud higher-income and healthier than in the past. They 10% The study y (ha y v am ing ong those with CDHPs also finds the following: 10% private insurance and age 21–64 and remained .) The unc arefollowin hanged i just as likely g n three questions were used in the Ju 2008. How to work for a ever, the gap large coin qualit mpany, and m y of ne and ore 8% — — 8% — offered through employer 25% plan enrollees and CDHP disappeared 15, mostly because 15 20^ of the significan 11 11* 18^t increase in the percentage of 20* 21* 26*^ or HSA (up from 5 percent 7% 18% in 2006), while 14 percent of employers with 500 or more employees offered one for CDHP enrollees. Tried to find information from sources other than health avera began to offe out-o Re ge fe de f-po duct recket maxim nce ibl 6% es acr r health reimbursem s oss al ulm heal may not th plans ent arrangem exc increased eed $5, by e80 nts (HRAs) ro0 f ughl or self-only y 20 pe . In 200 rcentc , o overage and 4, em r abouploy t $1 7%0ers were able to start offering 0, i $11, n7% 2000 08. 0 for See Ex family hibit 7.5 in $1,000– have an 10% HRA $1,499, 13 percent ge . However, it is standard pr tting $1,500–$1,999 and 21 actice among employers percent getting at least $2,000. that an employee must also choose a high- 10% Less than $1,200 labor unions; health care prov 16 iders and insure9* rs; government org 12anizations; and service firms. 5%* 5% 16% 35%* people with f Delayed or avoided getting health care due to cost (you or reported in Fi expenses, and choice of doctor. R amily gure 13, coverage who were enrolled in a 67 percent of persons in traditi oughly three-quarters of plan enroll CDHP, 70 percent reported that the onal plans agreed with the stat Offered CDHP ees, whether enrolled in 35%* em y were covered by ent, co 6% mpared with a traditional a is no m For the first ti ethodology section in the report me, the 2008 EBRI Consumer Engage so it is unclear how — ment in Health Care Survey many— health plans reported data and how the data exam — ined opinions Used online cost-tracking tool offered by health plan 15% 8 8 15% 12^15% 69 $750–$999^ 10 17* 20* 20* care s Figure 25, July Om likel atisfa ynibus Survey to Length cti have a choice of plan. Satisfaction with 15% on rates re of Tim plan on cost and qualit s to m i ea d ined between traditiona With C entify likel DHP and Savings y of care provided b y CDHP and HDHP respondents: l enrollees and HDHP enrollee ytAccount, 2008 doctors 1 heir plans is higher, although gaps still remain, and 21 ················································· 23 s. The differences in 28* 29 • In 2008, adu 15%* lt 30% s in CDHPs were significantly more likely to be in excellent or very good health than of the plans (up from traditional pla 11 percent in 2006). Mercer n enrollees reporting health care a notes that adoption of these plans slowed in 2008 and ccess issues due to costs. No significant access http://ehbs.kff.org/pdf/7790 $1,200–$2,399 .pdf. with useful inf 23 ormation! 20 23 4% deductible health plan in or family members) health plans with health savings account coverage, wi Source: 2005–2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys; 2008 EBRI Consumer Engagement in Health Care Surve th the deduc der to hav $1,500–$1,999 tible coun e an HRA tings (HSAs). towar .17 d t 19 h By 20 is limit. 16^ 07, 22^ The 7 per minimum all 31* cent of em 14% 33* 32* ploy owable deductible and 30* ers with 1 y. 37* 0– 38* 499 workers 29*^ 26 Overall, among persons eligible to con 12%tribute to an 12% account, 15 percent did not contribute anything, with • Fourth annual survey 5% HDHP or CDHP Offered 10% : This Issue Brief presents findings from the 2008 EBRI Consum 9% er Engagement in 5% 3%* plan with a family 57 percent of Figure 7, Sele plan, a CDH Pthose in HDHPs and 61 cted Dem , or an HDHP were ded Source: 2008 EBRI Consumer Engagement in Health Care Survey. uctib ographics, by le of $2,000 t extr T o em percent am 4,9 ype of Health Plan, 2005–2008 ely 99 and or veong those in CDHPs. ry 28 satisfied with the choice of percent reported a deduc ············································ tible of $5 doctor, and ,000 th or m e results have ore. 12 may regarding the have been weighted. 1 0% appropriate uThe report in se of lower cost sharing cludes data on HS as an incentive A characteristics, but to change the onl way y f individuals use the or slightly more than [ALL THREE 0% QUESTIONS TO BE ASKED OF THOSE AGES 21–64] 0% overall satisfaction levels by plan t reported rates Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). those with HDHPs or of cost-relate $2,400–$3,599 d acces m ype ore s proble fo traditional coverage. Pe und im n all pri s are lowe o15 r years of th r, mostly ople in CDHPs were significantly less likely to because of highe e survey 19 were reinforced in 4%18 r rates of acc the 200 ess issue 8 2 s 0% 0% issues were f 1 ound between CDHP enrollees and traditional plan enr 11% ollees during 2008, except Any of the above predicts adoption to 5% be moderate in 200 EBRI’s work advances knowledge and unders 8. See 29 30 28 33^ 44 tanding of emplo 44* 43* 43* yee benefits and their 48 49* 38*^ 35 8%12 3 maximum o HRAs are typically set up as noti ut-of-pocket li Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). 1mit will onal be indexed to arrangements infl and exist ation i23 n the future. only on paper Netwo . Employees beh rk plans may a impose ve as if 24 percent of and 11 2 percent of em those with ho ploy usehold inco ers with 500 me below $50,00 or more worker0 and 1 s offered either an HRA or HSA-eligible plan. 5 percent of those with household incom e of 7% Health Care Surve Traditional y, which provides nationally repr HDHP esentative data regarding the growth of ac CDHP count- been consistent since 2005 Chernew, Michael E., Allison B. Rosen, and A. Ma By HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. law, people in high-deductible health plan Separately More expensive than all , the survey asked if an individual’ 12 More expensive than some, (results not shown). s can have the cost of preventive services excluded from Less expensive than all s hea rk Fendrick. lth plan pro “Value-Bas 6% v About the same cost as ided 6% inform ed Insurance Desi ation on cost and 3 Don't know 6%2% gn.” quHealth ality of 7 0% $3,600 or more Traditional 20 HDHP 33* 27* CDHP 517,000 accounts. More i health care system. It found across-the-board strong 2 nformation can be found at iwww.ahipresearch.org/pdf nterest in select networks com s/2008_HSA posed of onl _Census.pdf y medical Health Problem** Traditional 5%* HDHP CDHP 5%* findings; Figure 26, among indivi how Am ever, overall satisfacti ount Currently in Accoun duals enrolled in traditi importance to on levels am on t, Am al health plans. the nation’s econo ong Persons With CDHP, 2008 ong CDHP enrollees in There is evidence that C my among policy creased between 2006 makers, ································· the news DHP enrollees are so media, and and 200 the public. It 29 7 and mewh at Permitted in have a health problem surance also HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. includes work than were adults i er’s compensation n, HDHP tort liab s or traditional pla ilities, and liabilities related ns. Adults in CDHPs were to ownership or the use 3 0% among higher-income individuals, but HDHP enrollees were more likely than those with traditional www.mercer.com/pressrelease/de12 tails.jhtml?idContent=1287790 for more information. Mercer’s 203 08 other plans but less expensive than other plans other plans money was higher CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Emdeduc ploy actually fundin ers ha tibles and out-of ve been interested in bringing aspects of g an acc -pocket li ount, but employer mits for ou s do not incu t-of-network s consum r expenses eeris rvices m into health . An i associ nated with the dividual plans for many can have a years. As health at least $50,000 contributi Don't know ng nothing (Figure 23). The 13 most significant difference in contribut 10 12 ions by 3 Traditional HDHP CDHP 2% 1. Choice of Health Plan, Pr Which of the based health plans and high-deductible following best describes emiums your current health insurance status: health , and Reas plans (HDHPs ons f ) and the im or Cpa hoosin ct of these plans a g Plan nd their deductible. This provision in Not filled a prescription due to cost providers. In Figure 8, Percentage Extre With respect to quality of c 0% Affairs dividuals were Web Exclusive (Jan. 10 mely mLook for these special features: oa or Very re tre rec h likely e legislation was designed to e eived, the 200 , 20 Satis to report that 07): 21 fied With Quality w195–w20 18 Offered HDHP 6 survey they had 21 3.19 found that of qn ual courage thos 30* Health Car ity inform 25* individuals in CDHPs and 24 atio e e with high Received, by n available than 25* 26deductibles to Type 25* cost HDHPs 26 23 providers wit 0% h records of h CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. igh-qualit does this b y care when co y conducting mbin and p ed with lower cost shari ublishing policy research, analysis, ng. About one-fifth of and special reports on * Difference between HDHP/CDHP and Traditional is statistically significant at p 0% Extremely Likely Very Likely others Somewhat Likely = 0.05 or better. Not Very Likely Not at all Likely Don't Know rem of pm ra oined at 4 o pr ee rt cost-co y (suc 9h as percent in 2008, while sat nscious in the automobile iir decision making than those nsurance). isfaction rates for traditiona in traditional plans, but the behavior l enrollees were unchanged. differences are significantly less likely to smoke than were adults in traditional plans, and they were significantly report was not available at the time this coverage to report access issues, especially am Source: 2008 EBRI Consumer Engagement in Health Care Survey. 12 Issue Brief went to press. ong those with a health problem3 and those with arrangement Source: until an empl 2005–2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys; 2008 EBRI Consumer Engagement in Health Care Survey. oyee incurs a claim. By contrast, w 15% ere employers to set up the HRA on a funded far back as 1978, em plan wi Source: 2005–2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys; 2008 EBRI Consumer Engagement in Health Care Surve th a deducti * Difference between HDHP/CDHP and Traditional is statistically significant at p b ploy le and maxim ers adopted Sec. 125 cafeteri um out-of- pocket lim a plans and flexible spendi it that qualifies = 0.05 or better. him or her ng accounts. to make a tax-free y. More recentl y, household inc ^ Difference from prior year shown is statistically significant at p 0%Source: 2005–2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys; 2008 EBRI Consumer Engagement in Health Care Surve ome can be seen in the likelihood 1 Traditional = 0.05 or better. of cont HDHP ributing at least $2,000 to the account. CDHP About 40 per y. - Skipped doses to make medication last longer (of those consumer engagement m No choice ore generally on the behavior and attit $1,000–$1,499 udes of adults with private health Choice Less Than 6 Months 6 Months to Less Than employee benefits issues; holding educational br 1–2 Years 3–4 Years iefings for EBRI memb 5 or More Years ers, congressional and Don't Know get preventive service inform were less likely to be satisfied than those ation, and CDHP and HDHP enrollees were less lik of Health Plan, 2005–2008 s an Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). d regular scre···································································································· ening tests lik in traditiona e ml plans. However, between 2006 and 2007, the gap i ammogra ely than traditional pla ms and colonoscopies. The survey n enrollees to report that the asked 16 n individuals were 1 1 extremely interested, one-quarter very interested, and one-third somewhat interested, American Association 1 Source: 2008 EBRI Consumer Engagement in Health Care Survey. of Preferred Provider Organizations (AAPPO) Among individuals covered by an employment-based health plan, those in CDHPs were more likely than Differenc Figure 27, not substantia W 0% Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). es i Am Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). hat we do mn o out-of-pocket costs r ount Rolled Over from e likely l. There is also evidence that consum to exercise. may Past Year, 2008 explain a signif ······································································· e icant portion of the r-driven health plans do difference in overall satisfaction not provide their enrollees wit 30 h # Difference between 2005 and 2008 is statistically significant at the p Source: 2008 EBRI Consumer Engagement in Health Care Survey. Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). household inc 2 ome of $50,000 or ab = 0.05 or better. ove. 22% basi who were given a prescription) s, they would incur the Nothing Less than $500 full expense at the tim $500–$999 21 e of 21 $1,000–$1,499 the contribut 23 21 $1,500–$1,999 ion, ev 32* en if an employee h 28* 28 $2,000 or More 30* 30 ad not incurr Don't Know 29* 24 ed 22 e contrib mployu ers have been increasingly turning their attenti 1 tion to an HS HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. A, but 1 Year the individual is not reqons to consumer engage uired to make a contribu ment in health tion or to ope care n an m acco ore unt. cent of indivi 8 -5% 2 duals with household income of at l federal agency staff, and th east $50,000 cont e news media; ributed $2,000 or m and sponsoring public opinion survey ore to the account, s on employee 2 insurance coverage. Findin 1 2 Source: 2008 EBRI Consumer Engagement in Health Care Survey. Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). gs are co • EBRI’s entir mpared with the 2 e library of r 005, 200 esear 6, an ch publications star d 2007 EBRI/Commonwealth Fun ts at the d people with deductibles whether the deductible applied plan pro Claxton, Gary, et al. “Heal satisfa I have health insurance through ction between those HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. v Source: 2008 EBRI Consumer Engagement in Health Care Survey. ided Nothing the inform Less Than $100 ation. One-thir th Benefits in 2008: Prem in traditional $100–$299 a gover d of adults plans and $300–$499 nment plan such as those with CDH in ito all m $500–$999 u traditional pla m Moderat edic $1,000–$1,499 al care or wh ely Higher, While Enrollm Pn s disappeare s reported that their health plans $1,500–$1,999 ether so d because sati $2,000 or More me services wer ent in Consumer- sDon't Know faction e although CDHP enrollees Source: HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account; 2008 EBRI Consumer Engagement in Health Care Survey. 3 were more likely than traditional plan and HDHP enrollees to be very interested in Only Medicare enrollees Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. ages 65 and older are allowed to pay insurance premiums from an HSA. A Medicare In 2007, AAPPO used the data from Inside Consumer-Directed Care (ICDC) and supplemented it with rates among traditional pla those with traditional cover any more information about provider cost a 2 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. na, HDHP, and CDHP enrollees. ge to have a choice of h nd qualit ealth plan, f y than oto her h llowed by those ealth plan typ enrolled in H es. DHPs. More Not filled a prescription due to cost or skipped doses to 1 1 • 1 Source: 3 Adults in CDHPs were significantly m 19882008 1989 EBRI Consumer Engagement in Health Care Survey. 1990 1991 1992 1993 1994 1995 1996 ore likely 1997 1998 than 1999 those with traditional healt 2000 2001 2002 2003 2004 h 2005 coverage to 2006 2007 have any expen • 3 se Individ HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. s. uals were mobenefit issues. re likely to report EBRI’s Ed that they ucation and Re had health quality search Fund in (EBRI-ERF) performs formation than to report h the charitable aving , 2 3 Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). broadl Both individuals and Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). yCDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. . In 2001, employ empl ers form oyers are allowed to ed a coalition to report health care provider qualit contribute to an HSA. Contributio y measures, and toda ns are excluded y whereas 20 percent of those with household incom CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. e of less than $50,000 contributed $2,000 or more to the HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), w/ account. Consumeris 1 Medicare, M m in Health Care Survey * Difference between HDHP/CDHP and Traditional is statistically significant at p edicaid, or Veterans benefits s. .................................................... = 0.05 or better. 1 excluded. M enrollee provided Figure 9, Per increased sig under age 65 3 Directed Plan the ore than one- m centage Extremely nificantly among t with information on the cannot use s Rises In S half (56 percent) of adults an HS hose with CDHPs and re or Ver A m tall Fir o main W pay y qualit Satisfied With im nss.” ueb page. Click on ra y nce prem Health Affairs of th in CDHPs, including eir doctors, co iOverall He u m m asined unchanged in 2008 (Fi . Web Exclusive (Sept. 24, EBRI Issue Briefs m alth Plan, by pared with about o those with coverage throug Type of Health Plan, n gure 8). The gap in e-qu 2008): and arter am EBRI w492 h thei ong –w502. r the concept (Figure 35). make medication last longer 2 2 But there was less interest i 29 n 27 actually 29 cha 28 nging to a select network com 40 35* 35 38* 39 b 38* ined with 34 32 data from 2 100 health plans Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). to determine that 10 million people were enrolled in an HRA or HSA-eligible than 60 percent of CDHP enrollees had a choice of health 3 HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. Source: 2008 EBRI Consumer Engagement in Health Care Survey. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. plan, compared with 56 percent of individuals in Figure 28, Following Treatment Regi As in previous y As the CDHP * Difference between HDHP/CDHP and Traditional is statistically significant at p * Difference between HDHP/CDHP and Traditional is statistically significant at p HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. ears of the and HDHP markets survey mens for Chroni , it was found continue to expand that individuals in c Disease, 2008 = 0.05 or better. = 0.05 or better. and more e ·············································· CDHPs nrollees are e and HDHPs nrolled for longer periods were 3 both less 30 HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. * Difference between HDHP/CDHP and Traditional is statistically significant at p high household incom educa e. Furtherm tional, and scientif ore, those in ic functi =CDHPs reported significantl 0.05 or better. ons of the Institute. EBRI-ERF is a tax-ex y higher incom empt organization e since HRAs CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. can be health cost thought information, and CDHP and HDHP enroll of as providing “first-dollar” coverage until fu ees were less nds in the ac likelycount ar than trae exh ditional plan austed. Source: 2008 EBRI Consumer Engagement in Health Care Survey. Source: 2008 EBRI Consumer Engagement in Health Care Survey. 2 the grou from ta 3 xable p is com 1 income i posed not onl f made by y of em the e plo myployer and ers but alsodeduc consum tible fr er groups and om adjusted orga gross income nized labor. In 20 if made 05, by account. 3 * Difference between HDHP/CDHP and Traditional is statistically significant at the p 3 = 0.05 or better. Delayed or avoided getting health care due to cost ^ Difference from prior year shown is statistically significant at p HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. 20 = 0.05 or better. 23 18^ 23^ 31* 37* 35 34* 44* 42* 32^ 32 I have health insurance through ^ Difference from prior year shown is statistically significant at p CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. 1 my job = 0.05 or better. or the job employ HDHP and C quality ers (5 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. ^ Difference from prior year shown is statistically significant at p of care satisf 2005–2008 1 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. 3 percent), reported that th DHP enrollees (Figure 30). With respect to ······················································································································ action rates remaine eir deductible a d between traditional enrollees and HD = 0.05 or better. pplied to all cost infor medical care mation, 26 pe (Figure 6). S HP enrollees. rcent of traditional plan eventy ······· -one 16 lower cost sharing: About * Difference between HDHP/CDHP and Traditional is statistically significant at the p Source: 2008 EBRI Consumer Engagement in Health Care Survey. 10 percent of Notes indivi for our in-depth and nonpar duals were ext = 0.05 or better. remely likely to cha tisan periodicals. nge, and one-fifth were very plan. More sCDHP = Consumer-driven health plan with deductible $1,000+ (individual), $,2000+ (family), with account. pecifically, 4.5 million people were in an supported by contributions and g HSA-eligible plan while 5.5 m rants. illion were in an HRA traditional pla • Enrollment l 3 Source: Mercer National Survey of Employer-Sponsored Health Plans and Bureau of Labor Statistics. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. ns, and 50 pe ow but growi rcent of those with a HDH ng: In 2008, 3 percent of t P (Figure 15). These results contrast wi he population was enrolled in a consum th findings er-driven likely of tim Appendix: Methodology than those in traditional plans e, the s Note: Percentages may not sum to totals due to rounding. ustained impact that these plans are having on cost, to recommend their health plan to a friend quality, and access to health care servic or co-worker and less likely es Tabl Leftover fund e of 2005. Those enrolled in C Contents s at the end of each y ear DHPs and HDHPs were al can be carried over to the so significantly less likely following year (at the employer’s to be between the 9 # Difference between 2005 and 2008 is statistically significant at p # Difference between 2005 and 2008 is statistically significant at p CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. 1enrollees to say * Difference between <$50,000 and $50,000+ is statistically significant at the p that the plan provided the inform = 0.05 or better. = 0.05 or better. = 0.05 or better. ation. In terms of use of information provided by Any of the above # Difference between 2005 and 2008 is statistically significant at p * Difference between HDHP/CDHP and Traditional is statistically significant at p * Difference between HDHP/CDHP and Traditional is statistically significant at the p 35 = 0.05 or better. 34 33 = 0.05 or better. = 0.05 or better. 37 48 50* 49 49* 58 55* 46^ 44 the i employ n * Difference between HDHP/CDHP and Traditional is statistically significant at p Note: Percentages may not sum to totals due to rounding. dividu ers started to focus al. The maximum an on value-based insurance d nual contribution = 0.05 or better. is esigns that se $2,900 for self-only cov ek to encourae grage and e the use of $5high-value ,800 for family Individu CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. al contributions to the account also vary by whether an individual has single coverage or family The catch-up contribution is not indexed to inflation after 2009. percent of tho enrollees rep Fronstin, Paul. Unlike satisfaction with quality of another family se in CDHPs orted that it w Consumer-Driven Health Benefits: A Continui with coverage throug m as provided by the health ember (s of care received, th uch as spouse or parent) h the indivi plan, com e differences in overall sa dual m .................................. p ng E a ar rket reported ed with about volution? Wa th one-fifth am eir deductible applied to shington tisfaction levels by plan 2 , DC: Em ong HDHP and ployee likely (Figure 36). Between 34 percent and 41 percent, depending on plan type, were somewhat likely to from in early 2005 and 2006, when indivi 2007. As in the AHIP study duals , there is no met with traditional coverage were hodology section in mo the report and ver re likely to have a choice of health y little information than those with traditional Figure 29, Access I No Health Problem** will be better understood. health plan (CDHP), up from ssues, bplans to st y Type of He 2 percent ay with their current health plan if alth Plan, 2005–2008 in 2007 and 1 percent in 2006. Enrollm ·························································· they had the opportunity to switch ent in HDHPs re 31 mained at discretion), allowing employees to accumulate funds over time, and, in principle, creating the key incentive ages of 21 and 34 compared with those in traditional plans, and along with those in HDHPs, more health plans, CDHP and traditional plan enrollees were more likely than HDHP plan enrollees to The findings presented in this Issue Brief were derived from the 2008 EBRI Consumer Engagement in Introduction coverage in services while discouraging the use of s ................................................................................................................... 2008, increasing to $3,00e 0rvices when and $5,950the be in 200 nefits are not justified by 9. .................... the costs (Chernew et 5 coverage. Specifically , individuals with single coverage are more likely than those with family coverage to EBRI Issue Brief is a periodical providing expert evaluations of employee benefit issues and I have health insurance that I purchase from a health all health car CDHP enrollees. Figure 10, type found in Benefit Research Institute, e service Percentage Extrem all prior s. years of the surve ely or Very Satisfied With • T 2002. o get answers to many fr y were reinforced in the 20 Out-of-Po equently asked questions about c 08 fin ket Health Care Costs, by dings (Figure 9). Traditional plan Type of change to a select network. overall, but t Not filled a prescription due to cost hese data should include workers, nonwor 11 13king adults, and children. 12 9^ 48 17 17 The 2007 report can be 16* 15 22* 13^ 12 plan than in 11 percent. dividuals enroll Overall, 9.8 ed in CDHPs (Figure 16). million adults ages 21–64 Also, fewer i with private insurance (representing 6.6 ndividuals with traditional coverage have percent of plans. However, the percentage of CDH 10 for individuals to make health care purch Pa enrollees re ses responsi porting that they bly. Employers ca would n place r be extre estricti mely ons or on very the amount likely to likely to be college graduates. There were few differences between CDHP, HDHP, and traditional report that they made use of the information about quality of doctors. CDHP enrollees were also Acc Health Care Surve ording to Claxtony et , an o al. (2 n0line surve 08 trends, as well ), 28 perc y th ent at exam o as cr f em itical analy plines issues surrounding co oyers s of es of fering emplo cov ye ee benefit po rage throug nsum licies an h HS er-driven health care, A- d proposals. qualified HD EBHPs RI Notes do nis a ot Summary al., 200 To be eligibl 7). of Findings............................................................................................................ e for an HSA, individuals may not be enrolled in other health coverage, such ............5 as a contribute less than $500 to the account, whereas individuals with family coverage are more likely than those Skipped doses to make medication last longer (of those insurance company .......................................................................................3 enrollees wer In terms of their use of infor Health Plan, 2005–2008 e more likely than CDHP a m ········································································································· ation provided by nd HDHP enrollees to be their health plans, 56 percent of extremely or very satisfied CDHP enrollees and with the over 17 all The survey asked a series a questions reg employee bene? arding wheth ts, click on Bene? er individuals agreed or disagreed with various t FAQs. found at www.aappo.org/UserFiles/File/HSASurveyandPressRelease/cdhp_report_final040207.pdf. reco a choice of health plan, whi Figure 30, Availabilit that c mmend their plan to a an be c that market) arried over were in either y and Use of Quality . friend or co- le the percentage of indivi a CDHP or a worker or stay with their p and Cost I n HDHP th n duals in a CDHP with a choice of health plan grew form at was eligible f ation Provided lan if theo by yr an HSA, but had not opened the ha Health Plan and d the opportunit Effort y to switch enrollees related to m periodical prov arital status, presen iding curren ce of children, age, and race. t information on a variety of employee benefit topics. EBRI’s more likely to try to find information on the cost and quality of doctors from sources other than the make contributions toward the HSAs that their workers establish. This accounts for 26 percent of covered workers who were given a prescription) including the spouse’s plan, unless that plan is This Issue Br cost of insurance, the ief presents findings from also cost of care, satisf a high-deductible the 2008 EBRI Consum 8 11 action with health care, s 8 health 7 15 plan er Engagement in Health Care . 15However 13atisfaction with their health 12* , individual 10 s are allowed 17 Surve 11^ y 10 . with single coverage to contribute at Health Plan Features and Demographics least $2,000 (Figure 24). ........................................................................................ Overall, 25 percent of individuals with single 10 60 percent of plan in all ________. “ I have other health insuran ye H ars of the survey traditional pla ealth Savings n Accounts and Other Account-Based Health Plans. enrollees indicated that th . In ce (specify 2008, 63 percent of traditional plan enrollees were _______________)................................. ey had made use of the information about quality of ” EBRI Issue 4 extremBrief, ely or no. 27 very 3 ways patients could receive lower cost sharing. The findings are in Figure 37. Two-thirds of CDHP from AAPPOs 2008 report, Distribution 47 percent to 63 s from an HRA f percent between 2005 and 2008o Stu r qualified m dy Of Consumer-Directed Health Plans edical expe 2007 and nses ar remained there in 2 e made on a tax-fav does not appear to be based on 008. This m ored basi ays. Employers be due to the increased bet O account. to Find Infor ur ween 2006 and 2007, and r mation From Pension Investment Report Other Sources, 2008 emained at 38 pe ····································································· pro rcent in 2008, while it vides detailed financial in fo was unchanged for traditional rmation on the universe of defin 33 ed enrolled • i n HSA-q Workers in both CDHPs and HDHPs were health plan. ualified HDHPs. more likely than those in traditional plans to be sole Not filled a prescription due to cost or skipped doses to care plan, reasons for choosing their plan, and sources of health information. It also presents findings from Health Status and Dem For this stud to have supp ylemental cov , an onlinographics e survey erage witho of 4, ................................................................................................. 532 u privatel t a highy -ded insu ucti red adults ages 21–64 ble for such things as was conducted t vision care, o dental ... prov 10 ide care, coverage contributed at least $2,000, while 44 percent of those with family coverage contributed at least I do not have health insurance currently .............................................................5 their doctors, Figure 11, satisfied with (Em Percentage Extrem p the overall health plan, com loy com ee B pared wit enefit Research Institute, S h 48 elypercent am or Very Likel • EBRI’s r pared ong HDHP enro eliable health and r ywith 49 percent am t eptem o Reco ber 2004). mme llees. Regarding cost inform nd Health Plan to ong CDHP etirement sur enrollees and 40 percent Friend or Co- veys ar ation, 40 percent e just a click Worker, enrollees and nearly 60 percent of HDHP and traditional benefit, defined contribution, plan enrollees agreed that patients who are actively and 401(k) plans. EBRI Fundamentals of Employee Benefit any can al 2008 dat so let employees use an HRA to p a. The report is based mostly on urchase heal 2007 da thta fro insuranc m Mer e directly from an insurer. Si cer and revised upward its nce unused 2007 estimate sim make medication last longer ple fact that an increasing percentage of the CDHP 14 18 population w 16 13 orks for an e 22 22 21 mploy 21* er with 500 20 25*or m 16^ ore 16 and HDHP e nrollees. 7 Health Status an d Demographics proprietors or to be employed in small firms. However, over the four years of the survey, workers • Individuals in CDHPs and HDHPs exhibit more cost-conscious behavior in their health care the 200 • Wor Higher inco k Status 5, 2006 .................................................................................................................... , and 2 me, better he 007 EBRI/Co alth: As before, this mmonwealth Fund year’ C sonsum survey fo erism und that adults in CDHPs were in Health Care Survey .......................... . The 200 14 8 EBRI nationall specific diseases, and i y representative data regarding t nsurance that pays a fixed he growth of amount per day (or other account-based health plans period) for and HDHPs hospitalization. and the impact $2,000 to the account. 11 Delayed or avoided getting health care due to cost Programs offers a straigh 13 16tforward, basic explan 14 21^ 31* ation of 28* 27 emplo26 yee ben 31* efit progr 35* ams in the 26^ 22 HDHPs among HDHP enrollees. It is also worth noti by enrollees used it, while 49 percent of traditional Type of Health Plan, 2005–2008 ······················································································ ng that satisfaction levels am plan enrollees used it, and 52 percent of CDHP ong CDHP enrollees increased 17 funds are participating i allowed to r n a program oll ov to er, employ maintain or i ee away thr s are mprove th able to ough the topic boxes at the top of the page. eir health shoul accumulate funds over tim d pay less for health care services than e. Employers can allow from 10 million to 12.5 million. The report does not mention any other specific data sources. The 2008 e Figure 31, Resources Used for Health Informa m In ploy t There was heo ees (Figure 7). ry, a rand a nearly om sam across-the-board incr ple of 2,008 yields a stat ease bet ition, by stical preci w een Type of Health Plan, 2008 sion 2006 and 2007 in the of plus or minus 2.2 pe percentage of CDHP ··························· rcentage points (wi 33 th 95 per- publications Trendsenrolled in CDHPs bec ......................................................................................................................... ame significantly more likely to be employed in large firms. .............................. 14 decision-making than individuals with traditional health insurance. Adults in CDHPs and HDHPs Consumer Engagem Individuals e of these plans and consum Figure 7 cont significantl nains data on dem rolled in Me y moe re likely nt in Health Care Surve er engagem dicare are thographic and health an those with traditional e no ntt eligible mor ye was general to status variables from conducted wit make HSA contributions, ly on the behavior a health coverage to have hi hin the Unite each of the survey nd attitudes of adults d States between August 1 altho gh h ugh they are able to ousehold s conducted with private income, to 4 Any of the above Concerning the length of time that CD private and pu HPblic enrollees have 20 sectors 25. Th 23 e been in the plan, 10 EBRI Datab 29^ 39ook on Emplo 38* 37percent enrolled in the past yee Benef 35 39 its 44* is a st 32^ atistic29 al [IF Q1 = 1,5, SKIP THE OTHER 2 QUESTIONS] Figure 33 enrollees use ________. “T from 37 percent to 47 dhe Future of it, though the difference percent between 2006 and Employment-Based Health s were not sta 2007 tis Be and tically nefits: Have Em remained at 49 significant. CDH ploy percent in 2 ers Reached a Ti P enrollees w 008, while satisfaction ere pping Point more likel?y ” former employees to use any leftover m patients who are not participating in the o program ney in the . Similar support was found fo HRA to continue to cover qu r indivi alified medical expenses. duals who follow Figure 31 Figure 20 Figure 11 report can be found at cent confidence) of what the results would be if the entire population ages 21–64 with private health insurance coverage enrollees who reported that their health plan was easy Figure 28 Figure 24 Figure 37 Figure 35 Figure 13 Figure 22 Figure 16 Figure 2 Figure 9 Figure 4 Figure 6 to understand, encourages adoption of a 8 healthier Less Than $50,000 Yearly Household Income When individuals have a choice of health plan, the premium affects their decision regarding which plan Health Savings Accounts • In 2006, it wa were more likely s found t ........................................................................................................ to conside referen hat i cndividuals in e work o r costs in their decisi n emplo Figure 26 CDHPs yee benefit pr ons about health care. Those in C and HDHPs ograms andwere work force-related issues. less likely than those in tra ........ DHPs and HDHPs 13 ditional and August 28, 2008, t be in better health, and to hrough a 16-m exhibit health inute Internet su y behavior. rve y. The national or base sample was drawn from between 2005 health insurance coverage. withdraw mo and 20 ney from 08. Inthe 200 The sa HSA for qua 8, adults mple in CDHPs were was rando lified medical mly significantly m expenses a drawn from S nd certai yo no re likely vate’s o n pre to be in excel nline sam miums. p Indi le lent or ver of m viduals also ore than y 2 six m onths, another 24 percent in the past year, and 41 percent in the past two years (Figure 25). Nineteen Cost-Conscious Decision Making, by Type of Health Plan, 2008 • Instantly get e-mail noti? cations of the latest EBRI data, Funds can be used for than traditional plan and HDHP enrollees to tr Figure 12, rates for traditional enrolle EBRI Issue Brief, Percentage Extrem out-of-pock no. 312 ( es wer ely et expenses and pr or Very Likel e unchanged. In Employee Benefit Research Institute, D yy to f Figure 18 toaddition, there was an incre emiums for in St ind ay inform With Curr ation on cost and suranc ent Health Plan If Had the e, long-term c ecem ase in HDHP e quality ber 2007). are, C of their doctor from OBRA, and nrollee were their treat surveyed menwith c t regimen. About Resources Used for Health Information, by Type of Health Plan, 2008 omPercentage Extremely or Very Likely to Recommend Health Plan plete accuracy. T Percentage of Individuals With Employer Contribution one-half of indi here are alsvi o duals thought that other possible sourc patients choosing less invasive es of error in all surveys that may be more www.aappo.org/UserFiles/ Percentage of Individuals Covered by Employment-Based Health Benefit File/HSASurveyandPressRelease/cdhp_study_2008_final.pdf. s Not filled a prescription due to cost 24 20 27^ 20^ 28 25 27 126 24 23 27 19^ lifesty Figure 32, le, provides inform Percent of Adul Agreement With Statements About Health Plan: Percentage Reporting That Annual Individual Contributions to the Account, by Type of Coverage, Percentage Extremely or Very Satisfied With Overall Health Plan, Distribution of Individuals Covered by Private Health Insurance, ation to Following Treatment Regimens for Chronic Disease, 2008 ts Who Agree That Term Agreement With Statements About Proposed Ways to Familiarity With Consumer-Driven Health Plans, 2008 Interest in Using Select Networks Composed of Only A Percentage of Adults Whose Deductibles Apply nnual Employer Contributions to the Account, help choose among pr s of Coverage Make Them oviders, and will protect them Consider Cost When in the event of an to choose. The 2008 survey found that 49 percent of CDHP enrollees in individual and employment-based Health Rei plans to be satisfied with the qualit were mbursement Arrangements more likely than those in traditional plan ............................................................................................ y of care they s to ask their doctor to reco received. However, between 2006 and mmend a less costly 14 2007, the Synovate’s online sam Amount Currently in Account, Among Persons With CDHP, ple of Internet users who have agreed to participate in resear 2008 ch surveys. More than percent report being in the 2. Which good health t million Internet users who agreed to participate in resear may not mak of the following han those with HDHPs or traditional health e an HSA co plan three to four best descr ntribution if ibes ythey are clai our health years, and 4 percent report havi plan's med as depe coverage. Two-thirds of adults with ch survey deductible: ndents s. A base samp on ng th another person’ e plan five le of 2,008 pa years or CDHPs s tax retur rticipants was m said ore. n. (Percentage of privately insured adults ages 21–64 Main Reason for Deciding to Enroll in Current Health Plan, retiree health sources other than the health plan. Specifically satisfaction from Opportunit benefits. Em 35 percen y to Change, by ployers t in 20 are n 07 t Type o ot required to 40 of Health Plan, 2005–2008················································ percent in 2 , 28 make unused balances av per008. cent of CDHP enrollees sought ailable to wor other sources of kers when 19 they serious t • Satisfaction gaps: han theoretical calcul CDHP enrollees in 2008 continue ations (Percentage of privately insured adults ages 21–64 of sampling error. These includ to have no e refusa 1 1 ls to dif be i ference in sat nterviewed aisfaction with qualit nd other forms of y of procedures should Skipped doses to make medication last longer (of those have lo With a Choice of Health Plan, by Type of Health Plan, 2005–2008 to Friend or Co-Worker, by Type of Health Plan, 2005–2008 wer cost sharing. Abo to Account, Among Persons With Employment- surveys, publications, and meetings and seminars by clicking ut 40 percent of individuals thought that patients using Contact EBRI Publications, (202) 659-0670; fax publication orders to (202) 775-6312. expensive illness. The percentage of indi Deciding to S (Percentage of privately insured adults ages 21–64 with chronic conditions who Engage Consumers in Managing Health Care Costs, by Type of Plan, 2008 eek Health They Strongly or Somewhat Agree, by Type of Health Plan, 2008 Medical Providers With Records of Providing High-Quality to All Medical Services, by Coverage Source, 2008 Care Services, 2008 by Type of Health Plan, 2005–2008 by Type of Health Plan, 2005–2008 viduals agreeing with these ········································································ statements in 2008 was unchanged from 34 Among Persons With CDHP, Among Persons With CDHP, 2008 2008 plans reported that their cost for insurance wa Satisfaction and Attitudes ..................................................................................................... s less expensive than the other available options .......... (Figure 17). 15 gap in satisfaction between those in prescription drug. There was no change in the sh traditional plans and those with are of CDHP enrollees who reported cost-conscious CDHPs disappeared because their health was excell 2,00 used to draw incidence rates for persons with acc Individuals w 0 adults (n=2,008) he o have rea nt or very good c ages 21–6 ched age 4 who om 55 a have health in pared with nd are ount-based health plans and just over one-half (54 percent) of those not y surance through an em et enrolled in Medicare m ploy HDHPs, and the base sample er or ay make catc purcha with HDHPs sed directly h-up When it comes to the money currentl who received health care in last 12 months) y in the account, 9 percent have no balance while 18 percent have who were given a prescription) Among Individuals With a Choice of Health Plan or in the 21 21 25 21 311 23 28 27 30 26 23 20 nonresponse, the effects of question wording and question order, and screening. While attempts are made to minimize leave. inform ________. “Sources of Coverage Differences in out- ation. of-pock Subscriptions to e who use the following resources a lot/some) t costs and Characteristi may EBRI explain a sign Issue Bri cs of the Uninsured: Analy efs ificant portio are included as part of n of the s EBRI is difference in overall of the March 2008 Current membership, or as part of a scientifically care co proven effective care should have lower co mpared with those in traditional plans, but a s st sharing, atisfaction gap re while between 30 mains for HDHP enroll percent and 40 ees. percent Extremely or Very Familiar Somewhat Familiar Not Too or Not at all Familiar Consumer Driven Mark 70% 100% strongly/somewhat agree that they follow their treatment regimens very carefully) Care Combined With Lower Cost Sharing, by Type of Plan, 2008 et Report (CDMR) (Percentage of privately insured adults ages 21–64) Based Health Benefits and CDHP, on the Sign Up for Updates box at the top of our home page. 2008 2007 levels. 60% 80% 20% 75% This com 75% 75%pares with 30 percent among both HDHP and traditional plans. Choice of Health Plan, Premiu satisfaction in decision making over the four creased significantly ms, and Reasons for Choosing Pla years of the su among those with rvey, but CDHPs there was n............................................... and rem a significant increase in the ained unchanged in 2 18 008. The Not filled a prescription due to cost or skipped doses to from 100% a carrier were drawn r 66%* andomly from the Synovate sample for this base sample. This sample was and 56 was co contrib percent of those with traditi m utio plemented with an additional ra ns. In 2008, a $900 c onal atc health coverage (Figure 7). h- 65%* u ndom p con oversam tributionple of these two grou is allowed. A $1,000 ps. ca More specifically tch-up contributio , the n will be $3,000 or m [A deductible ore (Figure 26) is the amount y . Overall, 47 ou have to pay percent had l before yoess than $1,000 in t ur insurance plan will start paying any part of he account at the time of the survey, your these factors, it is impossible to quNongroup Market, by Type of Health Plan, 2008 a $199 annual sub ntify the errors th scription at ma to y resu EBRlt fro I Notes m th and em EBR . I Issue Briefs. Individual copies are available Figure 13, satisfa People looke Differences i ction rates betwe Populatio Agreem d to a wide variety nn S ent With Statem overall urve en traditional plan, HDHP, and CDHP y satisfaction levels (higher satisfaction w .” EBRI Issue Brief, ents of sour About Health Plan: Pe ces for hea no. 321 (Washington lth inform rcentage Reporting That The enrollees. In neither ty ation. A ith traditional pla 55% , DC: Em majority ploy c ee Benefit Research onsulted phy ns) were reinforced in pe of health plan were y Strongl sicians y thought there Checked whether plan would cover 100% should be lower cost sharing for patients using high-quality doctors. According to enrollment estimates 92% from CDMR, more than 11 million people were enrolled in 86% HRAs or Figure 33, make medication last longer There was no Cost-Conscious Decision Making, significant variation in the 53% 9 frequency by 31 Type 29 of Health Plan, 2008 with which people with chronic conditions followed 33 28 38 31 ···································· 36 35 36 3334 32 28 40% 100% 61% Contribution Behavior and Account Balances................................................................................ 3 22 satisfa percentage of traditional plan enrollees reporti ction gap in quality 52% of care remained between traditional enrollees and ng cost-conscious decision m 1 212 3aking, which would 18% HDHP enrollees. The stratified by Information provided by physician gender, age, region, i 89% with prepa ncom ym ee,nt education, or for $25 each (f race. The response rate was 19.3 percent (12 or printed copies). Change of Address: EBRI, 1100 13th St. 92%* percent and 11 medical bills. oversam phased-i There are other reasons, however, why The survey asked responde percent did ples n by ] were: 1) those with either an HRA or an 20 care not 09.kn ow how m nts whether they uch was in the account an indi had ch vidual ronic conditions. For analyti HSA, and 2) may . With choose a particular health plan. When asked respect to rollovers, 16 per those with a HDHP witho 12 c purposes, reports of cent rolled ov 3ut an account er Orders/ Traditional HDHP CDHP Traditional HDHP CDHP frequently a majority Institute, Sept or Som and m of enrollees ewhat Agree, by any 67% went online to em ext ber 2008). 87% remely T or ype of Health Plan, 2008 v explore health information Web sit ery satisfied with the out-of-pocket cost ······························································ es, with adults in HDHPs and CDHP s in their health plan, but there 19 s with those in 70% the 200 90% HDHPs, 58% 8 findings. more likely58% to be college gra 2005 duates. There 2006 2007 were fe 2008 w difference 63%* s betw 63%*^ een CDHP, 63%* Delayed or avoided getting health care due to cost 18% 86% 2412 29 26 35^ Traditional 41 363 40 HDHP 37 CDHP 49* 90%* 40 34 33 60% their treatm HSA-eligible plans as of Januar ent regimen across plan t 49% 62% 57% y 2008 ( 49%ype 57% up slightl s. This isy in c from ontrast to so 10.1 millimewhat on in 2007, a mixed findi nd 6 mngs in illion i2007 n 2006). . Don't Know 2005 2006 2007 2008 64%^ NW, Suite 878, Washington, DC, 20005-4051; Traditional 2005 HDHP 2006 2007 (2 CDHP 02) 659-0670; fax number, (202) 775-6312; 2008 Health Care Use and Access Issues differences in explain why s o overall satisfaction me of the previously .............................................................................................. levels b found significant y plan type fdifferences di ound in all pr 3 sappeared. ior years of th 88% e survey ..22 were 50% Lower cost of the premium 60% 1 30% 2 36% 48%* chronic health conditi for the base sa but with ded Distributions ucm tibles that are generally ple or national sa from an HSA ons and fair or There’ 63% can m poor health were co pbe mad le, and 38 high enou s lots more! e at a perce gh t ny ti n om t meet the qualify for the me bined into an . An i oversa ndivid m inple). Th iu dicator of health p ng t al need hresho e not m ld to m argin of error for the 87% be covered by a roblems. People ke tax-preferred a high- nothing while about the m ain 38 percent rolled over at least $1,000 in reason for enrolling in a plan, 48 per Traditional cent of CDHP enrollees rep 2008 (Figure HDHP CDHP 27). orted that they enrolled Any of the above 39 42 41 47 53 48 53 51 56 53 48 45 50% m are significan ore likely Asked for generic drug instead of to 61% t differences say that they by went online plan type. a lot or som In 2008, Employee-Only 34% only 45 e (Figure 31). percent of traditional Family Friends or relatives were a plan participants were commonly HDHP, and traditional enrollees rel ated to marital stat 75% 4% us, presence of children, age, and race. 74% 35% 1 83% Furtherm Figure 34, Roughly 6 m ore, Trillion were in ends in Cost-Conscious Decision Ma in 2007, the surve Low out-of-pocket costs for the HSA-eligible plans and 5 m ye-m found that adults 56% ail: subscriptions@ebri.o king, by T with CDHPs and HDHPs 33% illiron were in g Me ype of Health Plan, 2005–2008 52%mbership Information: HRA-based plans. CDMR predicts 14 58%* were significantly Inquiries reg ·········· moarrding EBRI 36 e likely to • Choice of plan: Among individuals with employment-based health benefits, those in CDHPs were more 80% Internet/health Web sites 72% 79%* $50,000 or More Yearly Household Income Availability reinforced in and Use of Cost and Quality Inform the 2008 findings; howeveation r, ove................................................................... rall satisfaction levels among CDHP enrollees 55% 25 national sam Traditional • 75% For the first ti brand name drug ple was plus or m 8% me, the 2008 18% inus 2.2 percent. EBRI Consumer Engagement in Health Care Survey 68% examined opinions because of the lower prem were defined contributi deduc 60%tible ons as having a health problem if the heto such an account. High alth plan iu to 54%^ m with , while 47 percent reporte draw m 32%* o deductibles were ney from hi 32% y said they s HS d that the opportunit were in f defined as indivi A (altho air or poor ugh he m ydual de to save health or had at ust have been ductibles of at least $1,000 money in the account c least one overed by a subscriptions 16% No deductible 79% 58%* Fronstin, Paul, and Sara R. Collins. “Findings From consulted sou Figure 14, extremely or Trvery ends in Views of rce of health inform satisfi doctored with out-of-pocket costs, while onl Health Plan, 2005–2008 Visit EBRI on-line today: ation among people in all the 2007 EBRI/Co 36····································································· plans. y 17 percent of HDHP enrollee 17* About three-q m www monwealth Fund C 11* .ebri.org uarters of ind osnsumerism were ividuals in all 20 satisfi in ed membership and/or contributions to EBRI-ERF 15% 48% should be directed to EBRI President/ASEC 50% 67%* 2005 2006 2007 2008 67% million individuals will be enrolled in account-based plans in 2009. The data reported here were obtained report that they had avoided, skipped, or delay 4 Employee-Only ed health care becaus Family e of costs than were those with m 75% ore Not filled a prescription due to cost Trends likely ......................................................................................................................... than those with traditional coverage to have a 12 13 12choice of health plan. This 1250%* 74%24* 19* 19 .............................. 19*contrasts with findings 19 23*28 16^ 16 Conclusion 46% 75% increased bet 64% ween 2006 and 2007 and remained at 49 64% percent in 2008, while satisfaction rates 73% 39%*^ for chronic health conditi and fa To exam mily regarding the de ine the issues ductibles of at least $2,000. on out of the f appropriate u mentioned ab ollowing: ar se of lower cost shari ov The final sam e, the sam thritis, asth ple was assigned in ng as an incentive m pla, emphy e included 1,184 in HDHPs with ei sema or lung to one of to change three groups: th disease, cancer, the way 71% individuals use ther an HSA or ose with a for future high-dedu Individ years was cti uble healt al or a Single Cover Good network of physicians and main h pl reason for enrolling i an at t age he time the n funds that plan (Figure were placed 18). Am in the HSA). ong indivi Distributio duals with traditional ns are exclude d 75% 45% 38%* 40% 70% Talked to doctor about treatment Chairman Dallas Salisbury at the above address, (202) 659-0670; 62% 72% e-mail: salisbury@ebri.org plan t and onl 30% 50% ypes co y 23 Health Survey.” pnsulted their ercent of CDHP particip EBRI Issue Brief, health plans frequentl ants were satisfi no. 315 (Washington, DC: E y for info ed (Figure 10). rmation. More than ha mploy 47%* ee Benefit Research lf of individuals in all plans 49%* 61%* Institute, Work Status Health Care Use and Access Issues 69% 46%* Skipped doses to make medication last longer (of those 49% traditional coverage. In 2008, it was found that HDHP Figure 35, from Issue 7 in 20 50% Interest in Using Select Networks Com Friends or relatives 08 and available only to subscriber 45%* posed of Onl s and possibl enrollees continued to y M y ethose who request a cop dical Providers With Records be 66% mo74% re likely 47%*^ y . than traditional Lim 5 ited Cost-Sharing Incentives 50% from 2005 and 2006, when indivi ........................................................................................................ duals with traditional coverage were 41% mo 41% re likely to have a choice of ..........28 14% traditional enrollees wer hospitals/doctor in the network e unchanged. Differenc 44%* 45 es in out-of-pocket costs 44 33* may explain a significant 57%* 1 consumer-driven health plan (CDHP), t 50% the health care sy options and costs stem. It found hose with a across-the-board st high-deductible rong interest in health plan select networks com (HDHP), and those with posed of only depression, diabetes, heart HRA (CDHP from ta xable income i s), 1,634 in H f they are used attack or other heart di DHPs without accounts, to pay for seasqu e, high cholesterol, hy and 1,714 i alified medic n mal expenses ore traditional health plans. pertension or as defined 77%* high under Inter blood nal health coverage, 45 percen The 200 My 8 EBRI Consumer Engagement in Health Ca deductible is less than t cited the go $1,000 od network of providers an re Survey finds that enrollment in hi d 36 percent reported the lo 12 34%* Traditionalgh de w out-of-3 ductible 26% 39% who were given a prescription) 13 14 13 12 23* 20* 19 21* 16 21* 16 15 frequentl Figure 15, As in previous y March 2008). y Percentage of Individuals Co consulted m ears of the agazines or book survey, it was found s, with those i vered by 63% Employ that individuals in n CDHPs the m ment-Based Health Benefits With Choice 46% ost likely CDHPs t and HDHPs o do so. Fewer than half of were both less 53%* Traditional HDHP CDHP 38% People in both CDHPs and HDHPs 25% were more likely than those in traditional plans to be sole proprietors inform40% ation about the methodolo Prior experience with the plan gy used to collect the data was provided in 26 61% 52%* 24 the i 41%* ssue. 11* 44%* plan enrollees to report that the of Providing High-Quality y had Care Co delayem d b or avoi ined With Low ded getting any er Cost Sharing, by T needed health care services because of ype of Plan, Editorial B health plan than individuals enrolled in 60% oard: Dallas L. Salisbury, publisher; Steve Blakely, CDHPs. editor. Any Tw views expr o-thirds of individuals with an em 40%*^ essed in this publication and those o ployment-based f the authors should Conclusion The survey asked responde ..................................................................................................................... nts who had chronic conditions whether they agreed that they ................. follow 28 ed their portion of the difference in overall satisfaction rates between traditional plan, HDHP, and CDHP traditional he medical providers with records of hi alth coverage. Individuals were assigned to the CDHP and HDHP group gh-quality care combined with lower cost sharing. There 30%* if the 35% y had a was pocket costs as the pressure, or stroke. People Revenue Cod 25% Findings fro e (IRC) S m m No Employer Contributions a this survey in re 12% ason for enrolling in the pla ein CDHPs we c. 213( 56%* are co d). m Dist re significantly l pared with find ributions for n. in premiums fo 36% ess likely gs from the 2005, to have a health problem r COBRA, lon 2006, an 74% g-term d 2007 2 care i than were adults nsurance, health plans with a health savings account or health Not filled a prescription due to cost or skipped doses to My deductible is $1,000 or more reimbursement arrangement increased from 2 percent of Asked doctor to recommend less 37%* 37%* 40% adults in all plan t likely 50% than those in traditional plans and No Choic y 46%* Specific benefits offered b pes frequentl e of Health Plan, by y looked for health in to reco y the plan T mmend their health plan to a friend ype of Health Plan, 2008 21 formation in the newspaper 17 ·············································· or co-worker and less likely 15 , and even smaller share 21 s or to be em not be ascribed to the officers, Information provided by health plan ploy 55% ed in sm 55% all firms. One- trustees, 55%members, or quarter of other sponsors of the E workers in HDH 53% mploye 28%* Ps and CDHP e Benefit Research s were 73% Institute, the EBRI Educ 53% employed in firm ation and s 30% 54% 54% 35%* 41% HDHP 12% costs, but the 2008··························································································································· difference between traditional plan enrollees and CD 27%* HP disappeared, mostly············· because of the 36 treat Enrollm ment regimens for specific conditions carefully CDHP reported that the em ent in CDHPs and 2 51% 30% HDHPs ploy ................................................................................................. er contributed to . There was no the account. Among t significant variation in the hose eligible to con 2008 surve 31%tribute to an 38 y make medication last longer costly prescription drug 18 19 18 17 30 27* 27 74% 28* 28 29* 22^ 22 enrollees. 21% 11% 33%* 50% 11% in HDHPs or traditional pla deductible of EBRI/Co less interest i mmonwealth Fund Consum at least $1,000 for indi n changing to a select net ns: 45 percent of those in vidual coverage or $2,000 for fa erism in Health work com CDHPs r Care Survey bined with lower cost sharing. eported a health problem s. In past reports, the ter mily coverage. To be assigned to , com There was p m ared with comprehensive alsothe health insur Don’t ance while know a Plan's good reputation, 49% m receiving unem ount of individual ded ployment uctible compensation, and insurance while eligible for the U.S. adult Resear 50% ch Fund, privatel or their staffs. y ins Nothin ured populati g herein is to be co on in nstr 2007 to ued as an attem 25%* 3 percent in 2008. 48% 36% pt to aid or hinder the adoption This represents an increase fro of any pending legislation, regulation, m 2.5 Tay consulted a n than those with traditional Am lor ong the population with traditiona HDHP , Humphre u 20% rse advice or help line. 10%y. “Does Internet Research ‘Work’ plans to st 22%* ay l c with their current health plan if overage and a choice of plan, ? Comparing Online Surve 65% 39 percent were offered a CDHP they had the opportunity to switch y Results With Telephone with fewer than 50 workers, co 50% mpared with 16 percent of those in traditional plans (Figure 7). There was Delayed or avoided getting health care due to cost 30% 13 14 12 16^ 28* 30* 29 28* 331* 37* 29^ 25* significant increas 50% 19% e in the percentage of traditional pl 46% 23%* an enrollees reporting access issues due to costs. There Inside Consumer-Directed Care (ICDC) 10% in the frequen Appendix: M account, 15 p cye with whic thodology ercent contributed not recommended b h people with .......................................................................................................... y others chronic cond hing. 23% itions followe 22 d their treatment regimens 15* 6* ....... across plan 39 20% 57% CDHP group, the or interpretative 30% • As in previous y support (t rule, or as y o a m legal, u degree) regar st also have an account, su acco ears of the unting, actuarial, o dsurvey ing other way r other such prof , it was found ch as a health savings account (HSA) or health s patients essional advice. that individuals in could receive lower cost shari CDHPs and HDHPs ng, such as by were both 54 percent am Medicare other tha was used as ong those in traditional the descriptive label for what are now labeled n for Medigap, are plans, and 57 also tax-percent am free. This means traditional ong those with tha health plans. A label change was in t distri HDHPs. butions used CDHP to pay Medicare million peopl Fam Checked price of service before ily e in 2007 to Coverage 4.2 million in 2008. An additional 11 percent, or 13.4 million adults, had a health or HDHP, and 28 10% Magazine articles or books about health percent were not offered it, but 32 percent did not know if the 59% y were offered it (Figure 19). Any of the above Figure 16, plans (Figure People enrolled in CDHPs and HDHPs Surve Percentage of Individuals Co sy 11 and 12). s.” International Jo Similar to the satisf 30% urnal of M vered by were 24 ar acti ket Research Employ m 25 on questions, the ore likely 23 me26^ nt-Based Health Benefits With a Choice . Vol. 42 than traditional plan en 40 percentage of CDHP enrollees reporting , no 41*. 1 (August 2 40 40*rollees to consider costs 003). 45 47* 36^ 33 23% little difference in the share of enrollees who worked Familiar type of coverage, simple to for companies with 500 or more employees when 40% 9% Figure 36, were no significant access Likelihood of Cissues betw hanging to Se een CDHP enrollees and traditional plan e lect Network if Current Doctor was Not 64%* nin Select Network, rollees in the 2008 sur vey, Inside Consumer- getting care Directed Care (ICDC), an industry newsletter published by Atlantic Information types (Figure Refere 20% 25%nces28). Th ..................................................................................................................... is is in contrast to somewhat mixed findings in 2007 (Fronstin and Colli .................. ns, 2008). 41 In reimburse less likely actively ment arrange parti tha cn ipating in a m those in tra ent (HRA) wit program ditional plans h a rollover provi to maintain or to recommen sion that they improve health, d their health can buse to pa y plan to a friend or co-worker and following y for m treatment regimens, edical expenses Source: 2005–2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys; 2008 EBRI Consumer Engagement in Health Care Surve Part A or B, EBR order given that these plans are not as c Adults in CDHPs wer I Issue Brief is Medicare Ad registered in the U. e significantly less likely vantage S. Patent and T plan premiu ro adem mprehensiv ark 25% Office. ms, and the emplo to sm Ie as they Soke SN: 0887 than were adults in traditional plans: - were in the past and m 137X/90 yee share of 0887 -137X/90 $ . the premium for 50+. a y.y no longer be 50 13 percent plan with a deductible high enough to • Cost-related access i My deductible is less than ssues: In 20 make them $2,000 for m 08, HDHP enrollees continued t eligible for an e and my family HSA, of which 5.6 m o be more likely illion said that they than traditional plan understand 28 17* 7* Among the 39 percent who were offered either a CDHP or HDHP, 14 percent were offered a CDHP, 15 per- in their decisions about t that theyof Health Plan, by T would be extreme heir health care. Nearly ly yor pe very of Health Plan, 2005–2008 likely to recommend their plan 70 percent of adults in CDHPs ····························································· 25%* to a friend or and 3 in co-worker or stay 5 (61 percent) of 21 with co 1 mparing CDHP enrollees to traditional plan enrollees, though HDHP enrollees were less li 8% kely than 20% 20% 25% 15% except am Services, has Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). byong higher-income individual Type of Pl been following the an, 2008 ·········································································································· movement to consumerism and growth in account-based plans for m s, but HDHP enrollees wer 38% e found to be more likely than those with ·· 37 any 2007, people Endnotes 25% ....................................................................................................................... in CDHPs with arthritis and hypertension were significantly less likely to say that .................. the42 y followe d 25% less likely by using less-invasive procedures, and by tha Easy n access to care those with traditional pla 25%ns to stay using scientifically 19 with their current health plan if they had the 19 proven effective ca 8* re. of those in C or the abilit com 25% p 8% 30% rehensi DHPs smoked, com Checked quality rating of yv to take their account with t e. Prior research has shown that cost sh pared with 20 percent of hem should tharing has be th eyose with traditional change jobs. Indi en increasing acro vidua coverage (Figure 7). Peopl ls with onl ss the board in the form y a flexible e employment-based retiree My deductibl Newspaper stories e is $2,00 health be 0 or mnef ore for its are allowe me and md on a y 41% fami ta ly x-free basis. were eligible 2 enrollees to report that the for an HSA but did not y had dela have such an yed or avoide account. T d getting any hese findings are consistent with other recent needed health care services b 21%* ecause of cent were off those in HDHPs their plan if t ered a HD hey strongly had the o HP, and 10 percent were offe or pportu somewhat nity to agreed that the ter switch increased fro red 21% an HDHP ms of their m 30 p and did not 7%ercent to 39 p coverage know if the mae drcent between 20 e they m w consider cost when ere offered an 06 and HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. 22% traditional pla n enrollees to be employed in larger firms. 46%* traditional coverage to report access issues, especiall doctor/hospital Opportunity to save money in the y among those with a health problem 1 6 and those with years. The August 8, 19% 2008, report contains enrollment data by insurer for 24 insurers, while the August 22, their treat 3 ment regimens for their conditions carefully. But people in CDHPs with depression were spending account (FSA) w 25% opportunity to switch plans. However, t ere not included in the CDHP group. 23%he percentage of CDHP enrollees reporting that t Traditional hey would in CDHPs we CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. of hig Distributions her ded re also slightly m uctibles and co-pa for nonquali ore likely fiy ed medical e ments to exercise and a return to coinsurance (Fronstin, 2007). xpenses are but they were no less likely subject to re Employer Contributes gular i to be obese com ncome tax as well a pared with s a estimates of e 10% costs. But the difference be 25% Don’t nrollm know a ent in consumer-driven h mount of family deductible tween traditional plan ealth plans (See enro enrollees and CD llment sectio HP disappear n on pg. ed, m 38). ostly because more 10% 3 16% 9% 9% 9% account. deciding to se 2007, and re Figure 17, 10% Did you Pr re mained at 38 percent in 2008, while em ad e a doctor when sick or fill iu this as a m of Selected Plan Com pass-along? Staya prescription; a phea ared W d of it w em ith Other Available Plans, Am as unchanged for traditiona plo one-half of those in traditional plans felt this way yee benefit issues with your l and HDHP enrollees. ong Individ own subscr uipti als With on to EBRI 20% account, rollover funds for future 36% 10% 15% CDHP 14% 59%* 20% 22% 17%* 14%* Figure 37, household 6% inc Agreem ome of $50, ent With Statem 000 or abents ove. About Proposed Ways to Engage Consu to Account mers in Managing 2008 * Difference between HDHP/CDHP and Traditional is statistically significant at p , issue contains data from BlueCross BlueShield pl = 0.05 or better. ans. According to the data from these two issues, significantly more likely Advertisements to say they followed their treatment regimens 33% carefull 13% y than di 2 13%d those with Participated in wellness program 7% 7% Individuals were assigned to the HDHP group The rem be extre ainder of this repor 13%* mely or very likely to recommen t examines the findings fro d their plan to if they did not have m the 2008 EBRI Consu a friend or co-worker or stay an account used for health mer Engagem with ecare their nt in plan if adults in ot 10 percent penalty, w her health plans. hich is waived if the ow 12% ner of the HSA dies, becomes disabled, or is eligible for The self-reported health status of the CDHP populat traditional pla Issue Brief Don't know if have deducti for onl ny enrollees reported access ears y $89/ 12% year electroble nically e-maile issues due to costs. d to iyo on im 3 12%* u 11% or $1 proved between 2007 and 2008. 99/year pr 2 inted and mai 47* led. For more i The survey nformation 18% 11% HDHP 32% 6% 66% (Figure Individuals with CDHPs an 32). Choice of Plans and Those d HDHPs were less likely in the Indi 11% vidual Market, by T than those with traditional ype of Health Plan, 2008 insurance to say ············ 23 that ** Health problem defined as fair or poor health or one of eight chronic health conditions. 9% Trends Individuals with HDHPs reported that they had not opened an HSA for a number of reasons: offered through employer 10%* 5%* 10.7 m Individ illion Health Care Costs, by T uals were persons were more likely to report enrolled in an HRA or HSA- ype of Plan, 2008 that they ············································································· 26%* had qualit 7% eligible plan. The report y information than cos should i t inform nclude workers, ation, and 37 traditional coverage. 0% 10% Puts you in control of your health 8% 8% Health Care Surve about subscri they had the ptions, visit our y as they relate to dif opportunit W yeb site at to switch increased betwee ferences and www.ebri.org or compl similarities between individuals enrolled in traditi n 2006 and ete the form 2007, and rema below and r 3 eturn it to EBRI. ined at 38 percent in onal expenses wit There were some statisti h a rollover provision cally significant or portability demogr if they aphic differences am changed jobs. This group includes individuals with ong adults enrolled in the three 4% ^ Difference from prior year shown is statistically significant at p Medicare. = 0.05 or better. found that ad 5% 0% ults in CDHPs were significantly more likely to be in excellent or very 7% good health than t 7%*hose 6%* 35% 3% their health pl Adults in CDHPs were also m 0% an is easy to understand (Figure 13). 12 ore likely than tho HDHP enrollees were less li se in traditional plans to saykely than CDHP enrollees that 3%* they had checked 3 0% 4% CDHP • More cost-co 0% nscious behavior: Individuals in CDHPs and HDHPs exhibit more cost-conscious behavior 2% Over 2005–2008, ad care dollars, ults enrolled in CDHPs reported significantl 5%* you make choices of 12% 7 y higher incom 7 1%28* e. In 20 1% 08, 40 percent CDHP and HDHP enrollee Nurse advice line/help line Traditional s were less likely than traditional plan e 35% HDHP nrollees to report that the plan provided CDHP 4% nonworking adults, and children. While many insurers were not included in the analysis, Aetna, the Blues, # Difference between 2005 and 2008 is statistically significant at the p The 2007 survey Used online cost-tracking tool 3% 3% found tha12 t adults with =CDHPs 0.05 or better. and HDHPs were 4% significantly more likely3 to report that • Twenty-eight percent reported that they did not have the money to fund the account. 3. HSA-eligible health plans but m health plans, Do you 2008, while it have a special acco Health plan is easy to understand CDHPs, and was unchanged for HDHPs. The12 unt or f a Health plan will protect me in the y also include indi und you can report also traditional and HDHP enrollees. use to exa viduals with hi pay mines cons Health plan encourages me to for medical expenses? The accounts are umer engage gh deductibles who are not eligible to ment Health plan provides information more ge3 nerally 3% . It types of health plans. Adults enrolled in CDHPs were significantly 34% more likely than those in traditional with HDHPs Individuals a or more tradit re able to Traditional ional coverage. People in roll over funds f 10% rom one HS CDHPs HDHPA into were ano significantly ther HSA withou less likely CDHP t subjecti to have a health ng the Name Traditional HDHP CDHP 0% Lower cost sharing for Not much paperwork Lower cost sharing for Lower cost sharing for less 13 15 Lower cost sharing for 7* Lower cost sharing for high- and indi whether the plan would cover care. Ad Figure 18, vidua Mals with traditional coverage in Reason for Deciding to ults in CDHP Enroll in to report t Cur hat their health p s and HDHPs were rent Health Plan, Am lan encourages them mo ong In re likely than those in traditional dividuals Wit to adopt a healthier h a Summar 0% y of Findings in their health care decision provided by health plan 0% 10% 20% making than 30% indi 40% viduals with traditional 50% 60% 70% health insurance. 80% 90% 100% were in households with i 0% ncomes of $100,00 event of an expensive illness 0 or m 20%* ore, up from adopt a healthier lifestyle 22 percent in 2005 (Fig to help me choose among ure 7). 3 Just 14 the inform Cigna, Humana, and United were included. Collectivel ation. In terms of use of inform 1 ation provided by y, the health plans, CDHP and traditional plan y 2 account for about 140 million lives, and 9.3 they had avoided, skipped, or delayed health care because of costs than were those with more traditional som 0% etimes referred to as Health Savings Accounts active patients patients following treatment invasive procedures (HSAs), Health Reim scientifically proven bursement Accounts (HRAs), quality doctors contribute to exam 0% ines health plan features, enro an HSA. Individuals with t llee characteristi raditional hea cs,lth coverage include a broa satisfaction and attitudes, c d range of pla hoice of health plan, n types, plans to have distribution to income a • There was high househo Tax benefits of the plan a nearly Traditional ld incom nd penal across-the-board incr e: 40 percent of ty taxes as long ease bet those in CDHPs had incom as the rollover HDHP 3 ween 2006 and 2007 in the does not exceed 60 days. Rollover 4 es of $10 28* percentage of CDHP CDHP 0,000 or more, problem • 2% 0% Twenty than were adults i -two percent reported that the ta n0% HDHPs or traditional pla 25% x benefits were not attractive enough ns. Adults in CDHPs were significantly 50% 75% . less likely 100% to Organization Total Employment-Based physicians, pharmacies, labs, and Individual lifesty plans to ask t le. With respect to inform Source: Choice of Health Plan or i 2005–2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys; 2008 EBRI Consumer Engagement in Health Care Survey. hAllergies eir doctor to recommend a less costly Arthritis ation n the Nongr made available oup Market, by T Depression prby escription drug: About 3 i the health High Cholesterol ype of He plan provided to alth Plan, 2008 n 5 said the Hypertension individuals to help the ··············· y had done t 23 his, m percent of adults with CDHPs lived in Source: 2005–2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys; 2008 EBRI Consumer Engagement in Health Care Surve households with incomes under $50,000, down from 33 percent in y. enrollees were more likely than HDHP regimens plan enrollees to report that they m effective care ade use of the information about million of the This survey fi Source: 2005–2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys; 2008 EBRI Consumer Engagement in Health Care Surve Extremely interested 10.7 million persons covered by nds that in Very interested 0%2008, 3 percent of the Somewhat interested an HRA or 25% populat HSA-eligible. More i Not very interested ion was enrolled in a CDHP, up from 50% Not at all interested nform 75%ation about ICDC can y. Don't know 2 100% percent in coverage. The 2008 sur Less than $200Source: 2008 EBRI Consumer Engagement in Health Care Survey. v$200–$499 ey found that $500–$749 HDHP enroll $750–$999 ees continued to be m $1,000–$1,499 $1,500–$1,999 ore likely than traditional plan $2,000 or More Don't Know • Strong interest in reduced cost sharing 1 : There was across-the-board strong interest in consumer prem Personal care accounts, Personal me iums, plan choice, contributi Nothing Less than $500 on be dical funds, or $500–$999 havior among those with a CDHP, healt $1,000–$1,499 Choice funds, an $1,500–$1,999 d are different from $2,000 or More h care use, access i hospitals employ Don't Know er- ssues, cost com includin pared to 23 percent of 1 enrollees who reported that g HMOs, PPOs, those in traditional pl other manatheir health plan was ged care plans and plans with ans. Those enrolled in CDHPs and HDHPs w easy to understand, that the plan a broad variety of cost-sharing encourages ere also smoke than were adults in traditional pla contrib 1 uTraditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). tio Source: 2008 EBRI Consumer Engagement in Health Care Survey. ns from Archer MSAs are al ns, and the so permitted y were signific . Earnings o antly m n con ore li tribkely to exercise. utions are also not subject to Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). 1 co mA pd ared wit Traditional = Health plan with no deductible or <$1,000 (individual), <$2000 (family). dress h 50 percent of those in traditional plans (Figure 33). Few people participate in wellness • Seventeen percent reported that it was too much trouble to open and/or manage the account. Source: 2005–2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys; 2008 EBRI Consumer Engagement in Health Care Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). 2005. In cont Source: 2008 EBRI Consumer Engagement in Health Care Survey. 2 Source: 2008 EBRI Consumer Engagement in Health Care Survey. rast, there was little change in the incom 1 e distribution of people enrolled in traditional plans, the quality of doctors. CDHP enrollees were also more likely to try to find information on doctors’ cost and be found 2007Source: 2008 EBRI Consumer Engagement in Health Care Survey. , and enr at 2 www.aispub.com/Products/NewsICD.ht ollment in HDHPs remained at 11 percent (F ml. igure 2). The 3 percent of the population with a enrollees to report that the 0% 2 Source: 2008 EBRI Consumer Engagement in Health Care Survey. Source: 2008 EBRI Consumer Engagement in Health Care Survey. HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). y had delayed or avoided getting any needed health care services because of costs, engagem Source: 2008 EBRI Consumer Engagement in Health Care Survey. ents that could lower patient cost sharing, such as select networks (medical providers with arrange and quality provided HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. Source: 2008 EBRI Consumer Engagement in Health Care Survey. me Flex nts information, health care deci . The shared characte ible Spendin 2 g Accounts. ristic sion m of this group aking, and cost sharing incentives is that they either have no deductible or related to value-based deductibles significantly 1 HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. adoption of a 1 less likely to healthier lifesty be between the ages of 21 and 34 le, provides information to help choose am compared to those in traditional pla ong providers, and will ns, and, along income taxes Similarly Survey. , adults in CDHPs were . HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. significantly more likely than those with traditional health coverage to 1 1 Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). 1 3 Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). 2 programC 1 ity/S s offered by em tate/ZIP plo yers, but those in CDHPs were more likely to say they did so. Sim ilarly, although Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). Traditional = Health plan with no deductible or <$1,000 (individual), <$2000 (family). 3 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Nothing Less Than $200 $200–$499 $500–$999 $1,000–$1,499 $1,500–$1,999 $2,000–$2,999 $3,000 or More Don't Know 3 Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). 1 HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. with 23 percent in h Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). ouseho 3 lds with $100,000 or more in income. quality from 2 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Source: Source: 2008 EBRI Consumer Engagement in Health Care Survey. 2 sources other than the health plan. 2008 EBRI Consumer Engagement in Health Care Survey. CDHP represents 4.2 m • Ten percent reported that it Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). illion adults age was either to s 21–64 with o complicated or the private insurance, while the 11 percent with a HDHP y did not understand the option. but the difference betwe CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. en traditional plan enrollees and CDHP disappeared, mostly because of the records of hig HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. 2 2 HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. 3 h quality care), health promotion programs, and using scientifically proven effective care. insurance design. 2 Source: 2008 EBRI Consumer Engagement in Health Care Survey. 2 * Difference between HDHP/CDHP and Traditional is statistically significant at p 1 = 0.05 or better. have a high h HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. 1 ousehold i CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. ncome. Furthermore, those in CDHPs reported significantly higher income since HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. * Difference between HDHP/CDHP and Traditional is statistically significant at p 2 = 0.05 or better. * Difference between HDHP/CDHP and Traditional is statistically significant at the p CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. = 0.05 or better. 3 3 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Mail to: EBRI, 110 1 0 13th St. NW, Suite 878, Washington, DC, 20005-4051 or Fax to: (202) 775-6312 HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. 3 3 ^ Difference from prior year shown is statistically significant at p CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), w/ account. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. = 0.05 or better. 33 Source: 2008 EBRI Consumer Engagement in Health Care Survey. CDHP = Consumer-driven health plan with deductible $1000+ (individual), $2,000+ (family), with account. * Difference between HDHP/CDHP and Traditional is statistically significant at the p = 0.05 or better. ^ Estimate is statistically different from the prior year shown at the p ^ Difference from prior year shown is statistically significant at p CDHP = Consumer-driven health plan with deductible $1000+ (individual), $2,000+ (family), with account. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. * Difference between employee-only coverage and family coverage is statistically significant at the p = = 0.05 or better. 0.05 or better. = 0.05 or better. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. * Difference between employee-only coverage and family coverage is statistically significant at the p 3 = 0.05 or better. * Difference between HDHP/CDHP and Traditional is statistically significant at p 1 * Difference between HDHP/CDHP and Traditional is statistically significant at the p CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. = 0.05 or better. = 0.05 or better. # Difference between 2005 and 2008 is statistically significant at p = 0.05 or better. * Difference between HDHP/CDHP and Traditional is statistically significant at p Note: Percentages may not sum to totals due to rounding. = 0.05 or better. * Difference between HDHP/CDHP and Traditional is statistically significant at the p # Difference between 2005 and 2008 is statistically significant at p * Difference between HDHP/CDHP and Traditional is statistically significant at p CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. = 0.05 or better. = 0.05 or better. = 0.05 or better. * Difference between HDHP/CDHP and Traditional is statistically significant at p # Difference between 2005 and 2008 is statistically significant at the p = 0.05 or better. = 0.05 or better. * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. 10 28 18 22 32 14 42 38 40 2 4 13 35 15 39 25 41 7 9 3 5 EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI EBRI Iss Iss Iss Iss Iss Iss Iss Iss Iss Iss Issu u u u u u u u u u uIss Iss Iss Iss Iss Iss Iss Iss Iss Iss e B e B e B e B e B e B e B e B e B e B e B u u u u u u u u u ur r r r r r r r r r r e B e B e B e B e B e B e B e B e B e B ief No. ief No. ief No. ief No. ief No. ief No. ief No. ief No. ief No. ief No. ief No. r r r r r r r r r rief No. ief No. ief No. ief No. ief No. ief No. ief No. ief No. ief No. ief No. © 2008, Emplo 323 323 323 323 323 323 323 323 323 323 323 323 323 323 323 323 323 323 323 323 323 • • • • • • • • • • • No No No No No No No No No No No • • • • • • • • • • vemb vemb vemb vemb vemb vemb vemb vemb vemb vemb vemb No No No No No No No No No No yee B vemb vemb vemb vemb vemb vemb vemb vemb vemb vemb e e e e e e e e e e er 20 r 20 r 20 r 20 r 20 r 20 r 20 r 20 r 20 r 20 r 20 enefit e e e e e e e e e er 20 r 20 r 20 r 20 r 20 r 20 r 20 r 20 r 20 r 20 08 08 08 08 08 08 08 08 08 08 08 Research Institute 08 08 08 08 08 08 08 08 08 08 • • • • • • • • • • • www.eb www.eb www.eb www.eb www.eb www.eb www.eb www.eb www.eb www.eb www.eb • • • • • • • • • • www.eb www.eb www.eb www.eb www.eb www.eb www.eb www.eb www.eb www.eb ri ri ri ri ri ri ri ri ri ri ri.o .o .o .o .o .o .o .o .o .o .org rg rg rg rg rg rg rg rg rg rg ri ri ri ri ri ri ri ri ri ri.o .o .o .o .o .o .o .o .o .o -Educ rg rg rg rg rg rg rg rg rg rg ation and Research Fund. All rights reserved. EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org EBRI Issue Brief No. 323 • November 2008 • www.ebri.org 26 37 21 20 31 29 33 34 36 17 16 30 27 23 11 24 19 8 6 EBRI Issue Brief No. 323 • November 2008 • www.ebri.org 12 Figure 7 Selected Demographics, by Type of Health Plan, 2005–2008 1 2 3 Traditional HDHP CDHP 2005 2006 2007 2008 2005 2006 2007 2008 2005 2006 2007 2008 1,918 1,714 930 1,404 1,634 722 895 Total sample 1,358 1,506 487 186 1,184 Gender 50% 48% 51% 50% 57%* 54%* Male 49% 49% 53% 49% 57% 50% 50 52 49 50 43* 46 Female 51 51 47 51 43 50 Married 60 74 78 67 61 55* 64* 62* 59 61* 70* 71 Has children 34 42 47 42 33 35* 37* 37 40 44 45 46 Age 21–34 27 33 34 33 18* 24* 21* 20* 20* 24* 20* 23* 35–44 26 23 22 23 25 25 24 24 31 32* 31 30 Figure 14 45–54 29 26 27 26 34 29 30 29 34 28 30 28 Trends in Views of Health Plan, 2005–2008 55–64 17 18 18 19 24 22 25* 26* 15 16 19 19 1 2 3 Traditional HDHP CDHP Race/Ethnicity 2005 2006 2007 2008 2005 2006 2007 2008 2005 2006 2007 2008 White, non-Hispanic 71 71 71 72 94* 83* 78* 77 93* 81 75 76 1,918 1,714 930 1,404 1,634 722 895 Minority Total Sample 28 1,061 29 1,506 29 28 6* 463 17* 22* 24 185 7* 19 25 1,184 24 Strongly or somewhat agree that health plan is Household Income easy to understand Less than $30,000 15 68% 12 65% 15 64% 14 64% 1151%* 17* 46%* 43%*^ 12* 46%* 9* 54%* 11 45%* 13 53%*^ 6* 53%* 4* $30,000–$49,999 Strongly or somewhat agree that health plan 19 20 18 19 19 30* 18 14* 22 24 13 10* $50,000–$99,999 encourages adoption of healthier lifestyle 34 38 36 36 36 35 38 40 33 43 41 40 49 58 60 64^# 40* 44* 48* 52*^ 46 52* 63^ 63# $100,000–$149,999 14 14 14 14 11 5* 14 19* 13 7*^ 20* 25* Strongly or somewhat agree that health plan $150,000 or more 7779 4 3* 9 9* 9* 4*^ 11* 15* provides information to help choose among Education providers 55 67 66 67 40* 52* 55* 57*# 40* 56*^ 61^ 61# High school graduate or less 32 38 42 33 14* 17* 14* 13* 6* 11* 11* 10* Strongly or somewhat agree that terms of health Some college, trade, or business school 31 29 29 31 36 36* 30 28 28 33* 24 22* plan make me consider costs before seeing a College graduate or some graduate work 24 22 20 24 34 35* 40* 42* 46* 41* 41* 44* doctor or filling a prescription 40 46 47 50 61* 61* 60* 61* 72* 73* 74* 69*^ Graduate degree 13 11 9 12 16 12 17* 17* 20* 15 24* 24* Strongly or somewhat agree that health plan will Self-Rated Health Status protect them in the event of an expensive illness 75 72 72 72 67* 67 65* 67* 75 69 76^ 75 Excellent/very good 42 54 49 56 50 53 54* 54 58* 60* 65* 66* Source: 2005–2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys; 2008 EBRI Consumer Engagement in Health Care Survey. Good 45 35 38 34 36 34 35 34 34 33 29* 30 1 Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). Fair/poor 13 12 13 10 53 13 10 12 9 7* 6* 5* 2 HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. At least one chronic health condition** 54 49 49 52 56 50 53* 56 48 43* 45 45* 3 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Health problem*** 57 51 53 54 57 53 55 57 49 44* 46* 45* * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. Obese 36 30 27 26 33 28 30 29 26* 30 25 23 ^ Difference from prior year shown is statistically significant at p = 0.05 or better. Smokes cigarettes 23 24 24 20 14* 18* 14* 15* 14* 14* 15* 13* # Difference between 2005 and 2008 is statistically significant at p = 0.05 or better. No regular exercise 24 25 25 25 15* 25 20* 21 16* 19* 17* 17* Firm Size (base: employed full- or part-time) Self-employed with no employees 2432 9* 9* 9* 7* 8* 5 6* 7* 2–49 15 19 19 16 31* 32* 27* 26* 39* 32* 28* 25* 50–199 8 10 11 12 9 14 14 13 8 12 11 13 200–499 9898 6877 5* 10 87 500 or more 54 45 43 50 33* 29* 36 38* 36* 31* 40 42 Source: 2005–2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys; 2008 EBRI Consumer Engagement in Health Care Survey. 1 Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). 2 HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. 3 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. ** Arthritis; asthma, emphysema or lung disease; cancer; depression; diabetes; heart attack or other heart disease; high cholesterol; or hypertension, high blood pressure, or stroke. *** Health problem defined as fair or poor health or at least one chronic condition.

Volume 323

Pages 44

EBRI Issue Brief

Paul Fronstin

Health