Individuals in consumer-driven health plans (CDHPs) are more likely than those with traditional coverage to exhibit a number of cost-conscious behaviors, to be more engaged in wellness programs, and to be more inclined to think that financial incentives matter in holding down costs, according to a new survey by EBRI. At the same time, the fifth annual survey found that satisfaction levels for individuals in traditional health plans were higher again this year than for those in consumer-driven plans.

FIFTH ANNUAL SURVEY: This Issue Brief presents findings from the 2009 EBRI/MGA Consumer Engagement in Health Care Survey, which provides nationally representative data regarding the growth of consumer-driven health plans (CDHPs) 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 from this survey are compared with four earlier annual surveys.

ENROLLMENT LOW BUT GROWING: In 2009, 4 percent of the population was enrolled in a CDHP, up from 3 percent in 2008. Enrollment in HDHPs increased from 11 percent in 2008 to 13 percent in 2009. The 4 percent of the population with a CDHP represents 5 million adults ages 21–64 with private insurance, while the 13 percent with a HDHP represents 16.2 million people. Among the 16.2 million individuals with an HDHP, 38 percent (or 6.2 million) reported that they were eligible for a health savings account (HSA) but did not have such an account. Overall, 11.2 million adults ages 21–64 with private insurance, representing 8.9 percent of that market, were either in a CDHP or were in an HDHP that was eligible for an HSA, but had not opened the account.

MORE COST-CONSCIOUS BEHAVIOR: Individuals in CDHPs were more likely than those with traditional coverage to exhibit a number of cost-conscious behaviors. They were more likely to say that they had checked whether the plan would cover care; asked for a generic drug instead of a brand name; talked to their doctor about prescription drug options, other treatments, and costs; asked their doctor to recommend a less costly prescription drug; developed a budget to manage health care expenses; checked prices before getting care; and used an online cost-tracking tool.

CDHP MORE ENGAGED IN WELLNESS PROGRAMS: CDHP enrollees were more likely than traditional plan enrollees to report that they had the opportunity to fill out a health risk assessment, whereas they were equally likely to report that they had access to a health promotion program. CDHP enrollees were more likely than traditional plan enrollees to participate when a program was offered. Among those not participating, they did not participate because they could make changes on their own; they lacked time; and they were already healthy.

FINANCIAL INCENTIVES MATTER: Financial incentives for healthy behavior mattered more to CDHP enrollees than traditional plan enrollees. Financial incentives were a larger factor for CDHP enrollees than for traditional plan enrollees when it came to participating in wellness programs, choice of doctor, and the use of health information technology, as well as patient engagement using e-mail and the Web.

HEALTH STATUS IS BETTER, INCOME HIGHER: Adults in CDHPs were significantly less likely to have a health problem than were adults in HDHPs or traditional plans. Adults in CDHPs and HDHPs were significantly less likely to smoke than were adults in traditional plans, and were significantly more likely to exercise. People in CDHPs were also less likely to be obese compared with adults enrolled in a traditional health plan. Adults in CDHPs were significantly more likely than those with traditional health coverage to have a high household income. CDHP and HDHP enrollees were also more likely than traditional plan enrollees to be highly educated.

Figure 29, Annual Individu al Contri butions to the Account, by Hou sehold Income , Among Person s With CDHP, Trends Appendix—Methodology Unlike satisfac 11.2 Even amon The partici Indivi Contribution Behavior and Ac A s Trends $50, e remain ries millio 00 such as duals ar p0 or m ation a I have health insurance q n a g der ue ipersons not by act e able to o d ns tion w of t re in ults a two tions his re types o incom i were vely participat g ith es roll qual port 21– as par e. o f i we v 64 t ked r texamin er fu y of car Furthermor icipatin with llness e nds ing gar privat es the through my j g ein programs: a he r d fro in t in ea progr e, ce m g e insura h count Balances the one HSA i ived, t wheth findings eir em di am to maint ffer h e ployer n r i e ob or the job ce, from e dif ndivi alth n nce to another r fer e ’s t prese risk s duals ences i he we in acc aillness program, 200 assessment an n or im n a ting 8. g e n 9 EB HSA re ss issues b overa ed prove RI/MGA Consum witho 9 percent or dis ll satisfaction health, u a e d a fin t su g twe rancial of ee hea bjecting t e by d t nh with var lCDHP a tat market, l incentives h foll ee promotio rvels by Enga owing treatm he distri n ious d geme pla tra w n to participate w e d n program that a bution re nt itional t ys y in H either patients e pe nt re to i foun en ealth in gimens, roll nd i a co c still Car in ees that CDHP n o me an a uld clude e ll by d d Introduction Paul Figures References Fronstin is director of the Health Research and Education Program at EBRI. This Issue Brief was written with Figure 26 Figure 38 Figure 15 Figure 36 Figure 30 Figure 32 Figure 34 Figure 28 Figure 13 Figure 17 Figure 22 Figure 3 Figure 9 Figure 24 Figure 19 10 Figure 11 8 2009........................................................................................................................... Figure 1 ..................................29 • Programs for improving your health, like for weight loss, walking or other exercise, nutrition, stress management, smoking cessation, of another family member (such as spouse or parent)......................2 any of matter, regardless of were receive or wer prior ye penalty Survey as t not stati using a n e low tax i ars of nu a e h less inva e mb n s r ey relate to s cost sharing, as long as the HDHP that the survey er of tically signi di sive proce plan ty fferent co differences wa fic fntinue rollover ant in s eligibl indin pe, a types of durgs sho e n 2 d sd they , and and si e 008 in t does for be h be w ne e a seem to n by milarities amo 200 n not exc in came so i fi HSA, ts. usin Fi 9 gure fin It g scie e but matter d ein 1 foun d n 2 gs ha 9 60 ntifica . 0n d not (Fi Sixty d t 09. mo days. g i g h n lly ur Th at CDHP re to divi ope per e 3 proven ere wa Rollover contri dua 5 in n c). ent edivi d l e s T the acco s an almost ac enrolle effecti n of CDH raditiona duals rollees ar vd enroll e care, P e butions unt. in tra l plan n e mor roll ed d CDHP ross-the-bo enroll ees, 5 from Arc itional in CDH e like and HDHP ees 9 he l y tha P perce s. S h alth wer er arn d pla e MSAs are a n tr eventy percent t of difference more aditional en ns, CDHPs HDHP rollees likely plan l so in t were , 2009 and han of assistance from the Institute’s research and editorial staffs. Any views expressed in this report are those of the author Among i There has ndivi beduals wit en no clear h a incr CDHP, some rec ease in the sh eare of ive em CDHP ployer e c no rollees ntributio who ns to report cost-con the account,scious decisio while others do not. n makin HRA g over the a Chernew, Michael E.,Percentage Extremely or Very Likely to Stay With Current Health Plan Allison B. Rose Percentage of Individuals With Employer Contribution n, and A. Mark Fendrick. “Value-Based Insurance Design.” Health Affairs Web Percentage of Individuals Covered by Employment-Based Health Benefits With Likelihood of Changing Doctor if Cost Sharing Was Lower Number of Years Covered by Current Health Plan, Figure 1, Pre The findings pm resented ium Increa Annual Individual Contributions to the Account, by Type of Coverage, Percentage Extremely or Very Satisfied With Quality of Health Care in Percentage of Individuals Reporting Interest in Using Select Networks Composed of Only Medical thi Percentage Extremely or Very Satisfied With Out-of-Pocket ses Amon Preferred Source of Information for Health Plan Benefits, s Issue Brief Annual Employer Contributions to the Account, g Employers Wit were derived f hrom the 10 or Mo 20 T re 09 hat They Would Probably Employee EBRI/MGA Co s, Wo nsumer En rker Earni gagement ngs and Inflation, in Health Care Agreement With Statements About Proposed Ways to Engage Definit Employment-based h and so on. ions Individual Participates in Wellness Program Offered by Employer Among ealth Amount Currently in Account, Among Persons With CDHP, benefits are the most common form Main Reason for Deciding to Enroll in Current Health Plan, of health insurance in the Unite 2009 d States. In 2008, 160.6 Premium Increases Among Employers With 10 or More CDHP enrollees are no longer more likely than traditional plan enrollees to work for small firms, but HDHP enrollees I have health insurance that I purchase from a health enrollees to r traditional permitte CDHP a enrolle between HDHPs. more likely th es, an nd. tradit d The pla HD Ea r d 54 en HP enrol rnings o e port that ional enro port a percent an traditional plan llees lso ex n lees t they cont an reported that of a d CDHP o traditio m ributions had t be ines consum e plan h x enrol tremel e o nal enrol are p th pl tion to fill o l a ey wou ees, with a y or very satis n ler en lees so not subject enro to support ga ld pro llees CDHP gemen ut a agreed that b health r ably fied enro t the to incom more w partici use o ill th t ees isk assessmen gen h pati p e o e ta bei fat e lo ra e if n v ents who wer x erall g lly. e more a s. cost sharing t cash i The repor plan t. Speci like are in nc l y t e all years o actively ntive th f exami ically, an tra o en was partici d 41 n gage fitiona es h t pr perc hovided, e survey. p e pati atin lalth car pla ent of ents. g in n compa e CDH n a e In rolle pro decis 2P red 009, es to giram on- with Figure 30, Annual Individu al Contributions to the Account, by Type of Coverage, Among Persons With CDHP, enrolle five years of t and sho es w uld no ill get h t be e survey employer ascribed t (Figure contributio o the 6). offi Ho ce nw s rs, ebut ar ver, a statistic trustees, or ot e unable to make ally sign her spo ifica their nsors of EBRI, nt own increase contri in EBRI but the percenta i-ERF, or on. Indivi their ge dua s of traditional ls with taffs. an Neith HSA plan er can EBRI a a Exclusive, (Jan. 10 If Had the Opportunity to Change, by Type of Health Plan, 2005–2009 , 2007): wto Account, Among Persons With Employment- 195-w203. 1988–2008...................................................................................................................... When Using Doctors Who Use Health Information Technology (HIT) Choice and No Choice of Health Plan, by Type of Health Plan, 2009 by Type of Health Plan, 2009 ...............................7 Survey, an online survey Participate in Employer Wellness Program, by Various Financial thatProviders With Records of Providing High-Quality Care exami Health Care Costs, by Type of Health Plan, 2005–2009 Received, by Type of Health Plan, 2005–2009 nes issues surroun by Type of Plan, 2009 ding consumer-directed health care, including the cost of Consumers in Managing Health Care Costs, by Type of Plan, 2009 Among Individuals With a Choice of Health Plan or in million individuals under Those Offered a Wellness Program, by Type of Health Plan, 2009 age 65, or 61.1 Among Persons With CDHP, Among Persons With CDHP, percent of that population, had em 2009 2009 ployment-based health benefits (Fronstin, Employees, Worker Earnings and Inflation, 1988–2008 HRA and HSA were still mor eenrollme likely tha nt is n thgrowi ose in n tradit g, buti t oh nal e market plans to pen be sole etration r propri emai etors or to ns relative be ly s employe mall an dd t inh se a mall fi mount of rms. time insurance company ...........................................................................3 2009.............................................................................................................................................................30 86 rep 66 11 making, cost to maintain enrollees repo perc perc ort some sort of access issue. ent o ent o or f f a improve traditional CDHP enrollees and 76 perc rted t nd qual hat th ity in the pla eir ifo rn healt employ rmation, parti enroh llees shoul er o were extremely ffered a dent of HDHP pay cipation less for he in alth w enrollees h ri o ele r very sk assessment (Figure lness pro alth c satisfied with t are ser (Figur gram ve 1 s, opinions ices than 3). a S he ov imilarl 10), c pati about provi erall health pla ents who are y, 81 ompared with percent der e n not parti n of CDH , compar 31 gagement, perc P e cipati ent o ed nroll c with n fo g i ees st- n nor EBRI-ERF lobbies or takes positions on specific policy proposals. EBRI invites comment on this research. contribut enrollees re e th po eirting r own cost-con money t scious decisio o the account n makin and may g bet or m ween ay not also 2007 an re d 2 ceive 008 was fo employe llowe r contri d by a butions statistically signi . Two-thirds ficant For analytic pur 80% poses, reports of and Current Doctor Does Not Use HIT, by Type of Health Plan, 2009 chroni the Non-Group Market, by Type of Health Plan, 2009 c health conditions and fair or poor health were combined into an indicator of health problems. 25% 76%Combined With Lower Cost Sharing, by Type of Plan, 2009 Incentives and Type of Health Plan, 2009 Based Health Benefits and CDHP, 2009 insurance, the cost of c 60% 75% 75% are, satisfaction with health care, satisfaction with their health care plan, reasons for choosing 70% 20% 70% 70% 200 Figure 2, Dist 9a). In ev 80% ribution of Individuals ery year since 1998, premiu Covered by Private Health m increases have exceeded Insurance, by Type of worker earnings incr Health Plan, 2005–2009 eases and inflation (Figure .....7 December 200 I have other health insur 9 • No. 337 74% ance (specify _______________) ....................4 indivi • In 2 duals 00ha 9, a ve been dults in C in the DHPs w se pla ere significa ns is lower tha ntly less like n time en ly to rollehave a d in tra hea ditional cover lth problem tha age. Amon n were g adults in individuals HDHPs or with 100% 73% 73% Health Savings Accounts 75% said th 52 sharing incenti the traditional perc program. ey wo ent am pla ul nd The ong C ves related to enro proba dillees D ffer HP bly e an enr nce par d 22 o bet plan ticipate llees a w perc type een if n ent o d 40 the both and ifpercent amon r HDHP CDHP value-based in employab en an 2005 er o roll d HD ffe ees g HDHP 2006 surance HP en red t . When ime o rol enroll 2007 design, hea lees v asked acff, a ees. It c 2008 o ersus traditio mpared w bout t is also lth statu 2009h be ith worth availability of nsal pl 7 and enrol 0 an notin perc enroll ent o gl cee character health promotion that the overa ees was small f HDHP 72% en istic roll ll is, ees n Claxton, Gary, et al. “Health Bene 64% fits In 64% 2008: Premium Moderately Higher, While Enrollment in Consumer-Directed (63 percent) o decrease in cof st-conscious behavior i individuals with an em nploy some of ment-based C the answD ers from HP (incl in udi di nviduals i g both those c n tradit oional cover vered as an 71%^age. i 71% ndividual and those Figure 31, Length of Time With People were defined as having a heal 63% th problem if CDHP and Savings they said they A were in fair or ccount, 2009 poor .................................................................. health or had one of eight chronic health conditions 1 ......30 70% Traditional HDHP CDHP 40% their plan, an 50% 100% d sources of health informatio 52%^ n. It also presents findings from the 2005, 2006 and 2007 During the 2005–2009 survey period, 61%^ the Traditional CDHP popu HDHP lation became CDHP significantly higher income. In 2009, 34 percent 1): Health insurance premiums have more than 61%* doubled while worker earnings ab have increased 30 percent. In I do not have health insurance currently ................................................. 2005 2006 2007 2008 2009 5 c Health Reimbursement Arrange traditional traditional cove pla rage, n 60% s. Adults in 20 perc 60%* ent ha CDHPs an d been ments d H in their DHPs w plan e 2005 th re si regnificant e to 2006 four 2007 l years and 44 y less l 2008 ikely to smoke 2009 percent than five or 70%* wer meo a re years. dults in traditio This nal 70% 60%* Figure 3, Number of Years Cove Where the world turns for the facts 59%* red by Current Health Plan, by on U.S. employee benefits. Type of Healthab Plan, 2009 .................................... c 8 and satisfaction l choice o number programs, Plans Rises 66 percen but st f h48 ealt evels among C percent of CDHP enrol atistically signi t of tra h In pl Lower cost of the premium an, Small dpremi ition Firms.” al D u pla fHP enrollees increased m icant. s, plan nHealth A enrollees. If the em Simi lees choic lar a ffairs n support d e, contri 44 percent Web w Ex buti fro as f plo cl m on behavior amo u 37 of traditional o s yiund for er v percent e ( incr 27% See pased premiums for nonpartic indivi t.24 to 47 percent plan en , d 2 Traditional nuals 008 g th )ose with who rollees r : 39%* w492 foll between -w HDHP ow th e 50 a CDHP, ported th 2. eir tr 2006 and 2007 an 47%* CDHP satisfaction an ipant eat at tm h seir , ent re 77 perc employer gime ent of d d wer n. e A healt (arthritis, asthma, emph h savings account ysema o (H r l SA) is ung dis a ta ease, cancer, depression, x-exempt tr Premium Increase ust or custodial a diabetes, heart a ccount that ttack or other he an individual ca art disease, high choleste n use to pay for rol or health with family60% co 90%verage) reported that the employer contri 36%buteab d to the account, whilc e 32 percent reported that they did 60% 50% 60% a b 63%* 63%*cTraditional 63% HDHP 63%* CDHP Figure 32, Amount Currently in Acc EBRI/Common were in househw olds ealth with Funinc d C omes of onsumerism in $1 ount 00,, Among Persons 000 Health or mor Care e, up Sufr rvey, an om 22 pe With CDHP, 2009 d th rcent e 2008 in 200 EBRI ......................................................... 5 (Fi /MGA Consum gure 21). Just er Engagement 13 percent iof n 32 response, employers hav 46% e 86%* been 46%seeking ways to manage the 61%*^ cost increases. In recent years, employers have turned 45% 90% 54% Traditional HDHPab CDHP c compares plans, a with nd they wer 27 percent 55% 45% e an signifi d 20 cantly more lik 45% percent, respectively, ely to exerc amise. Pe ong persons ople in in CD a CDH HPs we P (Fi reg also less likely ure 3) 20% . While low to b 12 e er t obese han Low out-of-pocket costs for the doctor Traditional HDHP CDHP A healt Conch lusio reimbursement a n rrangement (HRA) is an employer-fun35 ded health plan 15* that reimburses 6* employees for qualified offer CD 52 perc attitudes, a About one-half of individuals hype HP rtension, high blood pressure e en d suc ent in 200 rol 35% h a n lees, 6 d pro health 9, whil 2 g ram. p care us 54% erce e Th nth t HD e d e thought th e an , or stroke). overall HP iffd acc erenc en rol satisf 53% eess i lat patients using ees, an beaction ssues. tweed n C rates 53DHP pe fo rce and tra r less n traditio t of invasive d tra itio nal e ditio nal procedures n nal pla rollees wer plan n en enrol rolle sh ees was unchan lould ees sa have not signif id they gedlow . e would participate. r cost shari icant. Howev ng, w er, 2 ith 9 care expenses. Contributions to the accou Less Than One Year nt are deduct Employee-Only 1–2 Years ibleTraditional from ta Family 3–4 Years xable in HDHP come, 5 Years or More eve CDHP n for individuals who do not not receive employer contributions, and 5 33%* percent did not know if the employer contributed (Figure 26). Figure 4, Familiarity With Consumer-Driven HealEmployee-Only th Pl 57%* ans, 2009.................................................................. Family .............8 60% 20% 81%* Worker Earnings Increases Health Care Survey. The 2009 EBRI/MGA Consumer Engagement in Health C 60% are Survey was conducted within the [IF Q1 = 1,5, SKIP THE adults with15% CDHPs lived in ho OTHER 2 QUESTIONS] useholds 51%* with incom32% es under $50,000, down from 33 percent in 2005. I49%* n contrast, there their attention 80% to accou Good network of physicians and nt-based health plans—a combination of health plans with deductibles of at least $1,000 for indivicompare duals witd h traditional with adults e con verage, rolled in a the traditio number nal h of pers ealth ons 77% plawith CDH n. 49%* Ps and the length o 77%* f time enrolled in these plans Figure 33, Amount Roll Fronstin, Paul. This survey was mad Consumer e possib ed Over Drivle with supp en Healt from Past Year, 2009 h Be ort from Am nefits: A Conti erican ............................................................................. 31% nuin Ex g Evolutio press, Bln? ueCross Blu Washington, DC: eShield Associati Employee B on, Expr ene................ fit ess-S Rescripts, earch 32 medical ex50% pe 60% 40% 80% nses. HRAs 76% 50% are typically combined with a high-48%* deductible health plan, though this is not required. HRAs Retirement and health benefits are at the heart of w 52%* orkers’, employers’, and our nation’s percent of HDHP enrol Availabilit both CDHP and HDHP enrollees 50% y and Use of Cost and Quality Information lees reported th significa e av ntlailabil y more l ity of a ikely h than tra ealth promotio ditional pl n pro an enroll gram, si 46%* ees to agree gnificantly lo wiwer than th the statem offer ra ent. tes itemize their taxes, and tax-free distributions for qualified medical expenses are not counted in taxable income. 74% Tax- 50% 45%*^ 45%* 40% 12 The 2009 EBRI/MGA hospitals/doctor in the network Consumer Engagement in Hea 71%*lth Care Survey 40 finds that 440 percent of the 27* population was enrolled 9 36% United States was little chanbetw ge in t een he Augu incom st 8 an e distri d A butio 29% ugu nst 20, of peo 20 p09, t le e 71% nh rolled in rough a tradit 14-minute ional plans, Internwit et survey. h 27 perce Thne natio t in house nal or holds base with Figure 5, Cost-Conscious 70% Decision Making, by Ty 70% pe of Health Plan, 2009.............................................................10 employee According to Claxton, et al. -only 30% coverage a (2008 nd tax-pre ), 28 pe 45%*rcent of e ferred savings or spe mploy Overall Inflation er 45%* s offering ndin coverage throu g accounts that work gh HSA-qualified HDHPs do not m ers and their families can ake contrib use utions to pay Diff Findings from the 2009 EBRI/M has be erenc Institute, 200 en eincre s in 50% out-of asing. 2. -pocket costs may explain a significant portio GA Consumer Engagement n of the difference in overall satisfaction rates IBM, John economic security Deere & Co., Kais . Fo er Perma unded in 1978, EBRI is nente, MetLif 68% e, Pfizer, athe most authoritative and objective source of nd The 34% Commonwealth Fund. can als Among th o be e of 70% 63fere perc d on ent a s with ta nd-a an em lone ployer bas c iso or w ntributio ith com n, 1 p0 r ephensive ercent insur received less ance that than doe 51%* $50 s not use 0, 24 perc a hient betw gh deducti een ble. $500 – among C About 40 Dper HP -cent of and tra in ditio divi nal duals thou plans enro ght t llee hs at pat . ients us42% ing scientifically proven effective care should have lower cost Figure 34, Perce free distributio 50% 70%ns are ntage Extremely or Very Satisfied Wi also allowed for 66% certain premiums. th Quality of Health Care Received, by Type of Health 50% 35% Prior experience with the plan 33% 25 23 15* In theory, the 50% incentives of CDHPs are designed to promote heightened sensitivity to cost and quality in people’s 64% in a CDHP, up from 3 percent in 2008. Enrollment in HDHPs increase 38%*^d 38%* from 11 percent i 32% n 2008 to 13 percent in 2009. sample was dr 2. Which of toward the HSAs that their awn from the following woSy rker no s establish. This account best descr vate’s 26%online panel ibes your health plan's d of s for 26 Intern percent of cover et users whoeductible: have agr ed workers enab eed t rolled in HSA-qualified HDHPs. o participate inc research sur veys. $10 • 0,0 Adults in 00 or 40% more in CDHPs wer incom e signif e. icantly more 62% likely than those with tradition 39% al hea 39%lth cov 39% erage to have a high Opinions About Provider Engagement their out-of-pocket health care expenses. 31%* 47%* 44% Employers first started offeri 62% ng account-ba 62% sed health plans in 2001 when a 36%* betw een traditional plan, HDHP, and CDHP enroll 39%*ees. In 2009, 52 perc Traditional ent of traditio HDHP nal plan partic CDHPipants were Figure 6, Trends in information on these critical, complex issues. 40% Cost-Conscious Decision Making, by Type of Health Plan, 2005–2009 30% ................................... 29%*^ 12 Cost- Employees ar $999, 26 perc Cons e eli ent cious Beh g re ible ceive for a d bn etwee avior HRA only 38% n $1,0 wh 00–$ en th 1,4 eir 99, 11 emplo perce yer offers suc nt received bet h a health ween $ pla 1n ,50 . 0–$1,999, and 22 percent Plan, 2005–2009..........................................................................................................................................33 in Health Care Survey sharing, whi 40% le about 30 Specific benefits offered by the plan percent thought there should be lower 34%*^ cost sha 21 ring for pati 13* ents using high-quality 12* doctors. 30% 29% 42%* 29% decisions about their health care. Yet the ability of people to make informed decisions is highly dependent on the 25% 40% 15% Overall, 11.2 30% 60% 60% million adults ages 21– 56% 14% 64 with private insurance, representing 8.9 percent of that market, were either in a 55% Over 2, With respect t household inc 000 10% ado ults (n familiarity ome. C =2,007 wi D) ages HP a th a C n 21 d H DHP, to DHP 61 perc 64enro who llees ent o have were f he those with alth also insur more a ance CDHP were likely t throu han tra gh a extremely or v nd e itiona mployer or l plan e ery familiar pu nrolle rchased es to be h with dire it ctl igh (Fi y from ly gure ________. “Health Savings Accounts and Other Accou 31%*nt-Based Health Plans.” EBRI Issue Brief, no. 273 (Employee handful of employers began to offer health reimbursement arrangements (H 53% RAs). In 2004, employers were able to 30%* 32% CDHP enrollees were more li extreme ly or very satisfie Plan's good reputation, recommended by others d wkely than ith out-of -poc tradiket costs (for tional plan enr heal ollees to th care 11 take services other advantage o 10 th f an for partici pr p 24%*^ atin escription dr 9 53%* g in a welugs lness ), while 13 HSAs are owned by the individual with the hi 33% gh-deductible health plan and are completely portable. There is no use-it- received $2,000 or more (Figure 27). Employer contributions vary, however, by whether an in 31% di23%* vidual has employee- For th e first time, the 2 25% 009 EBRI/MGA Consumer Engagement in Health Care Survey included questions regarding the Figure 7, Availability and Use of Quality and Cost Info In theory, a random sample of 2,007 yields a statistical precision of + rmation Provided by He 2.2 percentage points (with 95 p No Employer Contributions, alth Plan and Effort to Find ercent confidence) of what the results Figure 35, Perce extent No statistically to whic 30% 40% h they signi ntage Extremely or Very Sati ficant have ye access to usef ar-to-year chu an l in ge w formation. sfied Wi as observe th Overall He d in t 2he perc alth Plan, by entage of the population re Type of Healthporting that Plan, th ey [A deductible CDHP or were in is the amount you have to pay before your an HDHP that was eligible for an HSA, but had not o insurance plan 34%* pened the accwill start paying any part of ount. 30% The theory behind account-based plans and plans with higher deductibles is that the cost-sharing structure is a tool a carrier were drawn Prescription drug coverage ran20%* domly from the Synovate sample for this 35 base sample. 23*This sample was 33%* 10* stratified by gender, 4). In Bene educat contras fit Resear 50% ed.t, 9 Thperc ch ere Institut ent o were f f individu e, ewS dif eptem fere alsber 20 nces 12% with traditional by pla 04). 12% n typ c e as overage were they relate to 20%* extremely or v gender, age, a ery fami 20%* nd rac liar e. with a CDHP, and start offering 30% 25%health plans with health savings accounts (HSAs). By 2008, 9 percent of employers with 10–499 workers By Paul Fronstin, Employee Benefit Research Institute Employers hav EBRI focus 50%e a tr es solel emendoy us amount o on emplo f y flexi eeb benefits research — no lobb ility in designing health plans that inc ying orporate or advocacy an HRA. For exam ple, the p 20 rog perc ram, either the health risk assessmen ent o 30% f HDHP enrollees were satisfied an 34% t or the health promotion pr d 29 percent of CDHP participants ogram. Slig we htly re satisfie more tha 32% d n(Fi 70 percent gure 36). of CDHP or-lose-it rule associated with HSAs, as any money left in the account at the end of the year automatically rolls over only or family 20% 30% coverage. Individuals with employee-only 18%* coverage are most likely to 18%* get an employer contribution EBRI E Information From Ot mployee BeneEmployer Contributes to fit Researcher Sources h Institute Issue B , 2009 rief (IS........................................................................................... SN 0887 -137X) is published monthly by the Employee Benefit Research In............ stitute, 12 importance of would be if the e 20%nvarious ways i tire population ages 21–64 n which prov with p idrers of ivate health in healthsurance coverage care services enga were surve ge their yed p with complete accurac atients. Eighty-seven y. There perc are also ent of 2005–2009...................................................................................................................... 32% 17%* 43% .............................33 your medical bills.] were in excellent or very good health, though the longer-term tr 28%* 16%*end appea 42% rs to be upward. Also, no statistically 3 that will be more like Familiar type of coverage, simple to understand ly to engage individuals in their health care, compared with persons enrolled in more traditional 17% 22 21 9* 27%* age, r 11 perc egio ent o n, ifn ic nome, an dividuals d rac with e. an Th HDHP e re we spon re e se rate was xtremely o 27. r very 4 percent familiar (21 with perc a CDH ent for P. the base sample or nat 30%* ional Cop11 yright Inf 00 13th S EBRI stand t. N ormation: W, Suite 8s alone in em 78, Account, 63% Wa This re shingt port on, Dpl is Coyee ben , 2 copyright 0005-4051, efits rese e at d by the Em $300 pear r ye ch a ar ploye or sis an inde e in Be cludnef ed as pend it R pa ert se eof n arch Institut t, nonprofit, and no a membership e su (EBRI bscript) ion. npa . It Pe may rtisan riod be i- amount of and 20 percen money that t of employers is placed with in t 500 or he accmore work ount, the lev ers eoffer l of te h 10% d e eith deducti er an HRA or ble, and the HS c A-eli omprehe gible nsive plan.n ess of the health 40% 28%* 29%* enrollees part 20%icipated in the health risk assessment, compared with 56 percent of traditional plan enrollees (Figure 11). and is availa 20% ble in the following year. 13%* Health Plan Features and The other possible sources of erro betw seen urvey as $500ked i –$750, f a wh n indivi ile r in those wit all survey dual’s hea Demographics s that h lth fam ma pily covera lan y be mo provide re ge ser dar iious than theoreti nfo e mo rmation st likely t onc cost and quali o al calcu get an lations o emplf sampling error. oyer contri ty of providers. In butiThese on of at l dividuals include ref east were usals 40% The traditional 2009 EBR plan I enro /MGA Easy access to care llees Cons an um d 90 er Eng perc agem ent o ent i f bot n Hea h HDH lth PCare and C SD urvey s HP 19 enrol uggests that C lees reported t 17 DHP hat it enrollees are somewha was 8* extremely or very t more 10% signific • cal CDHP e s ant yea posta 20% 25% gn erolle r-to-year rate e pai s are no d in cha Wasn lon hges were ob ingtg oe n, D r more C, and a se likely t d rved i ditional hn an tra mail the inpe g o ditio rcentage ffice na s.l P pla OSn T with e MAS nrolle T at least o ERes to work : Send ad ne c dr 9% es h for s ronic co ch small fi anges nditi to:rms, but EBRI Iss on, wit 9% ue Br HDHP h aief hea , 11l00 th ___ Figure 8, Sources of Inform _____. “The Future of Em ation for Heal ployment-Basth Plan Benefit ed Health Benefits: Have s, by Type of Employers R Plan, 2009 eac............................................... hed 25% a Tipping Point?” EBRI Issue ...13 Figure 36, Perce coverage. 20% Thi orga s study fi 14% n nization. It analyzes a tage Extremely or Very Satisfied Wi nds evidence thatnd rep adults i ort ns re CDH sea Pth Ou s were rch data t-of-Po more without spin o li cket He kely than alth Ca thos r unde e in re Co rlying a traditional sts, by Type of Healt gend pla a. All fin ns to ex dhi ing h bit a s, sample, and 38 percent 5% for 21% the oversample). The margin of error for the national sample was ±2.2 percent. As in used without previous permission years of the bu s t citation urvey, in of t divih du e source als in C is re DHPs a quire nd H d. DHPs were found to be less likely than those in traditional 15% 20% 20%* 20%* insurance are all subject to variation. Employers often cover certain preventive services in full, not subjecting them to Similarly, 53 20% percent of CDHP enrollees participated in a health promoti 19% on program, compared with 42 percent among to be intervie25% wed and other Opportunity to save money in the account, forms of nonresponse, the effects of question wording and question orde 8% r, and screening. While attempts are $1,013t 00h S (Figur t. N 10% We 2 , Su8 it). e 8 I 78 n f , Wa act, 73 shingto percent n, DC, 20 of 005-4 individu 051. Copy als w right ith 2009 fami by E ly coverage mployee Beneget fit R a co esearc nhtribution Institute. A of at ll rights r least $1,000, eserved. No. 337. with more likely to 25% 30%report that they had EXEC quality informat UTIV ion a 18%* vailable E SUMMAR than cost informatioY n, an d HDHP enrollees were less By law, important t peopl 15% hat e their in high-de doctor duc co tmmunicate ible health d pl ans can with them so have that the co they st o coul f pre d really ventive servic underst es excl and what uded fr theom their doctor w dedu as sa ctible. ying cost-conscious in t No deductible heir decision making than those in traditiona 15% l 15% plans. CDHP enrollees were more likely than traditional The probl study a Brief, e enrolle m, in Plan, 2005–2009................................................................................................................ no. th les w so fin wheth e p 31e 2 e re drcenta (Employe s th e still more r on fi e fo genan llo of the e B wing: like cial data, enefit l po y than t Researc pulat option ih on cons ose i h Institute, sn , or tre traditional idered nds, are reve obes Dec pl ee, mber ans to be sole and i 2007 aling an n the ). perc pro d reli enta prietors or able — the re ge reportin to be g th aso employ at they .......................... n EBRI informatio ed ex in small ercise 34 n is number Employers of hav cost-conscious e been interes behaviors. S ted in bringin peci gf as ically, t pectsh o ose i f con ns CD umer HPsenga were gement into health plans for many more likely than those in t 11% raditional years. As coverage to far 30% plans both to recommend their health plan to a friend or co-worker and to stay with their current health plan if they In ord Figure 9, Preferred Source of Information for er to10% 20% qualify rollover funds for future years for tax-free contributions to an Health Pl HSA, the i an Benefits, by ndivi 13% 1dual 19% mus Type of Pl t be cover 1 e ad n, 2009 by a hea 47* .................................... lth plan that has an 15 the deductible . Employers can offer comprehensive health insurance that covers 100 percent of health care costs after made to minimize these factors, it is impossible 10% to quantify the errors that may result from them. traditional plan enrollees. 13% 17% likely tha 29 percent get n tradtitional ing $1, plan 000–$ en1,49 rollees to 9, 14 perc report that th ent gettine g $1 plan ,500 provi –$1,99 ded t 9, and 30 he information. percen T t getti hereng w a at s n leoast differ $2,0 ence 00. in the Individual or Single Coverage 6% 16% 16%9% plan This (Figur and HDH provision e 14). the gold sta Whil Pin th enro e e l not lar llees egislati to ng dard fo e, the have reported that t on was di r priva ff desi eren gn te analysts a ce betw ed to enco heen ey ma tr ura nd de aditional de ge us tcisi he of th ose with high on plan make e i enrolle nformation. rs, gove deduct es anrd C nme ibl CDHP a D es HP an nto t policy get nd H d HD prev m DH ake HP enrol P enro entive serv rs, the media, and llees lees were also ices and was 10% 20% To e regula xfirms. amin rly. e th 10% 10% e issues mentioned above, the sample was divided into one of three groups: those with a consumer- Recommended C itation: Paul Fronstin, “Findings From the 2009 EBRI Consumer Engagement in Health Care say that they back as 1978, had c employers a hecked d wheth opted Sec. er the 125 plan wo cafeteri uld cover care a plans and f (61 per lexiblecent C sp 8% end Ding HP vs. acc 50 percent ounts. Mor tr e raditional ecently, e ); asked mployefor a rs 8% had t Figure 37, Perce he opportunity to s n Puts you in control of your health care dollars, tage Extremely or Very Likely to Re witch14% plans (Figures 37 and 38).co Simi mmlar to end th Hee satisfaction alth Plan to Friend o 14%* questions, th r Co-Wo e perc rke enta r, by Type of ge of CDHP annual deduct 10% ible of not less than $1,150 for self-only coverage and $2, 7% 300 for 7% family coverage (minimum deductible the deductible has been met or they may offer coverage with cost sha 7% ring after the 7% deductible is met. If employers 20% 12% 12% 0% 6% Figure 10, Employer Offers Wellness Program, by Type of Health Plan, 2009 11% 11% .......................................................15 FI perce FT • H AN Indivi ntage Nduals i of UA the publi My deductible is le L CDHP a SUR n CDHPs were VE c nY . d tra : This ditional Issue Brief more likely ss tha plan e n $1,000 presents fi nrollees than those with report nding ing t s from traditional cov he availa the 2009 bility o EBRI erage to f cost a /MGA Consumer exhibit a number of cost-conscious nd quality in Engagement formation. A 5% in bo Health ut 40 regula statistically significant. 14 ________. r scree “Sn ources of ing tests like A Cov ppr e mammograms and colonosc rage oximately t and Ch ha re racteristics of e-quarters of opies. i the Uni ndividuals r T nh sured e surve eported t : Analysis of y aske hat it d p t e was extrem h op e Marc le with de h 200 ely ductib 9 Curr or very im 6%* leent s wh Pop e port the ulation r the ant more likely to 5% try to find info 10% rmation a on their doctor’s11% cost and quality from sources other than th ce health plan. driven health 0% 0%plan (CDHP), those with a high-deductible health plan (HDHP), and those with traditional h4% ealth Survey,” EBRI Issue Brief, you make choices of how your account is spent no. 337 (December 2009). 9%* 6 7 31* gene have cont Permitted insura ric dru inue g 10% ins d to t nce also includes w tead o urn t f a heir brand attentio name orkers’ compe n to c (56 perc onsumer e nsation, tort ent CDHP nga liabilities, and liabilitie geme vs. 46 nt p in ercen heat traditio lth care s related to o more nal); t w broadly. 3% a ne lked to rship or the use In the 2 ir 001, doctor a of em prope 5%*ployer brt out y (such s as Health Plan, 0% 5% 2005–2009 ......................................................................................................... b .....................34 The enrolle EBRI es re /MGA Consumer porting that th Engagement ey would be extr in Health Ca emely or very re Survey likely to asked r recom espondents th mend their pla eir reasons for n to a friend o not r co-worker partici 9%* pating in amounts are increasing to $ Traditional 1,200 aab nd $2,400 in 2010). Cert HDHP ain preventive services can be cove 2% 2% CDHPred in full and are not choose to Overall, amon payg less than 100 perc persons eligible to contri ent oab f health car bute to an e acco expenses unt, 1 after 1 perce the ntdeductible did not contri has been m 4%* bute anythi et, they then hav ccng, with 17 perc e te hnt of e 8% The Employee Benefit Research Institut 8% e (EBRI) was founded in 1978. Its mission is to 5% 0% 6%* 7% 6% Care S percent of CDHP an urvey, My deductible is $1,000 which provi d trad diti eTraditional Traditional s o nationally nal plan enro reor more presentativ llees reported e daaccess to quali ta regardi HDHP HDHP ng the ty informatio growth of n consumer-driv , compared CDHP CDHP wi eth 29 n health percent plans of • Survey.” A behaviors. mong in EBRI di T vidu h Issue Br ey w als w ere mor ith ief e no me p. 33 lo likely to say ym 3 e(Employ nt-base th d ee B h at they ea elne thfit b ha eRes ne d ch fe its, arch I ecked wh thos nstitute e in C ether their D , Sept HPs w emb e plan re m er 3%* wo o 2re 009a uld likel ). cover car y than th eo ; asked se withfor a Indivi deductible a that their duals i doct n p plied to al CDHPs were or 1) Not much paperwork worked l memuch more lik dical car with them to e or wh find ely than ether some 6%* realistic those in tr ch se anges t rvic aditio es were 10 hat th nal plans to excluded. ey could make rece 6% 14 Nearl ive in to y 6 i improve formation n 105* (57 he about t alth, an perce 5% n ht) of eir d 2) to he ad alth ok ults in Figure 11, Individual Parti 10% cipates in Wellness Program Offered by Employer Among Those Offered a Wellness coverage. automobile insurance). Individuals were assigned to the CDHP and HDHP group if they had a deductible of at least $1,000 for pres formed a coa cription 0% dr litug o ion to r ptions eport an d cos health ts care pr (44 peovider rcent Cqual DHP vs ity measures, an . 35 percent tr d today the aditional); gr talk oup is ed to compos their doc ed tor about not only othe of r 0% their employe increased from r’s 30 percent wellness pro to 39 percen gram. contribute to Nearly 60 perc t betwe , to encourag en 20 ent 06r an esponded e, an d 20d to enhanc 07, and that t re hey did not ach e the developmen ed 45 p pa ercen rticipate t i t of sound empl n 20 beca 09. Ove use they ro one yee ben coul -hal d make effit subject to th0% e deductible. Lower cost sharing for The out 3%* -of Lower cost sharing for -pocket maximuLower cost sharing for less m may not exceed $5 Lower cost sharing for ,800 for self-only cover Lower cost sharing for high- age and $11,600 for Figure 38, Perce option o those wit f h des ho 0%iusehold incom gninn g th tage Extremely or Very Likely to Stay e plane below with or $ witho 50,0u 00 a t a ma nd 9 ximum percent out-o With Cu of those with household f-pocket rrent Health Pla limit. nincome o If Had the Oppo f at least $50,000 rtunity to Don’t know amount of individual dedab uctible c 2% EBRI explo 0% Tax benefits of the plan res the breadth of employee benefits and related issues 3 3 24* (CDHPs HDHP e traditional gene ) an nrolle ric d dru e high s cov (Fi g i -d g ns ee ur rage to 1%* duct tead o e 7). ibl fe he Similarly, just a have br alth and a choice of health pla name; ns (HDH over one talkPs ed to ), a -thir plan. their nd d of the 4 d T C w impact oD o ctor about HP -thirds and of of thes traditional pr indi es ev pla cription iduals ns pla awith nd co dr n enro u a g opt ns nllees em umer ions ployment reported access an enga d cos geme -base ts;nt talked t dmore Cto cost DHP o CDHPs, incl Report availability: responsibi Program, by Type of lity f udio ng t r coordi hose w This r natin ith e g coverage port is th Healt eir car availa h Pl thro e wi an, 2009 ble on th ugh th other their .......................................................................................... provi e I em ntpl edrnet oyers (5 ers, spe at www cialis 6 perc .e ts, or testing f b ent), ri.org reported that t acilities. h Th eir d re edu e-quarters o ctible ap............ pfl ied to a 16 ll bene Choi Who we are fits e ce of Health Plan, Premiums, and Reasons for Choosi ither throu Printed Handbook gh a We Traditional b site Web Site or via e-mail. C E-mailDHP and H In Person HDHP DHP enrollees Telephone were als ng Plan o more l Other CDHP ikely t Do Not Get Any han traditional plan individual coverage active patients in wellness or $2,000 for family c patients following treatment overage. To be assi invasive procedures gned to the C Don't Know, 5% scientifically proven DHP group, they mus quality doctors t also have an account, Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005–2007; EBRI/MGA Consumer Engagement in Health Care Survey Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005–2007. Source: EBRI/MGA Consumer Engagement in Health Car If employer offered If employer offered programs and soIf employer offered und public policy If employer increased through objective If drug cost sharing research and educati If employer made on. EBRI is the only , e treatment o employers but ptions and costs also consumer(40 percent groups and Corganiz DHP vs. 3 ed la 3 pe borcent tra r. In 2005, dition eal); as mployers start ked their doctor ed to focus to rec ono value mmend a l -based e ss Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005–2007; EBRI/MGA Consumer Engagement in Health Care Survey Extremely or Very Likely Somewhat Likely Not Likely , changes on t (55 percent) o 0% 0% 0% heir o f tra Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. d witional n (Figur ple 12): an enrolle One-qu es warter ere extrem (26 perc ely ent) or very lik cited th ely t is as a major rea o recommend stheir on and one-t plan, compared with hird cited it as a 32 per- 15 family cover Change, by Type of age, with the deducti Health Pl bNo Choice le counti an, 2005– ng toward this 2009 ...................................................................................... limit. The minimum allowa Choice ble deductible and maximum ....... out- 35 contributing nothing (Figure 29). The most significant difference in contributions by household income can be seen in 0% or Booklet Information ________. Family Co “A EBRI studie vailability, ve program rage Con s the worl tributions, Acc d of health and retirement ben regimens ount Balances, and Rollovefit erss — issue in Accou effective care nt-B s such a ased Hea s 40 lth 1(k)s, IRAs, retire Plans, 2006–2009.” ment Only Medicare e 2008–2009. Survey, 2008–2009. nrollees ages 65 and older a cash incentive time off re allowed to pa discounted premium y insurance premiums premium for non- from an HSA. A was reduced Medicare enrolle additional contribution e under age 65 cannot gene information, rally on c th oe mpared with behavior anone-qu d attituarter des of of HDHP adults wit enroll h pr ees. ivate health insurance coverage. Findings from this survey are reported th their doctor a 2008–2009. 0% at b the em out other tr ployer eatments and c contribut private, nonprof ed too the account. sts; asked thei it, nonpartisan , Amon Washington, DC-b r doctor to r g person ecommend a s eligibl ased organi e to co zat less costly pres ntribut ion com em to itted exclusivel an cription account, dr yug; to medical enrolle traditional es to care pla pr (Figure nefer enro a to rec llees, 20). e 7 Si ive 3xty-three percent informat of iperc on t HD ent of those in hHP e rough nrolle e-mail es, and a and 70 CDHPs Web site. CDHP percent of CDHP with coverage throu en en roll rollees r g ees w h the eindiv e re ported that mor idual market e likel it y tha was re n ported Extremely Interested Nothing Less than $500 Very Interested $500–$999 Somewhat Interested $1,000–$1,499 Not Very Interested $1,500–$1,999 Not at All Interested $2,000 or More Don't Know Don't Know such as a health savings account Health Risk Assessment (HSA) or health reimbursement arrangement Health Promotion Program (HRA) with a rollover provision that they Figure 12, Re a asons for Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). Not Participatin g in Employers Wellness Program Among Those Offered but Not cos There insurance tly pres is no st designs that cri a -5%patutory re tion dr Less than $200 ug seek ( quir 39 ement t perce to encoura $200–$499 nt CDH hat a gn e $500–$749 P t employ vs he use . 34 perc ee of hi $750–$999 hav ent gh e -v a traditio alue high-de $1,000–$1,499 service naldu ); ctible develop s whil $1,500–$1,999 hea e ed discou lth a bu plan i ragin dget to ma $2,000 or More n or g th der to e use nage also have of servic Don't Know health care es w an HRA. h en a participants to HRA/HSA cent of minor reason HDHP Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). for not enrollees. Th particie p perc ating. enta Lack ge o o f individu f time was als e the seco xtremel nd-most y or very popul likely to ar reason for stay with their hea not participatin lth plan g, with if they Among i of-pocken t lim divi Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). incom d itu are als covere indexe e adeq d duacy, co t bo y infl an ation. employm nsum Ne er-drive twork plans m ent-bas n b edenefits, Socia heaay lthimpose plan, t hi h l ose Security, tax treatment of both retireme gher in de CDHPs ductib wer les and out-o e more likely f-pocket limits than thosent and health w foir out- th use an HSA to p the likelihooTraditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). d a of contri y insurance p buting at l remiums. east $2,000 to the account. About 41 percent of individuals with household income of EBRI N otes, My deductible is le n Nothing bo. 11 (Em Less than ployee B ss tha e$200–$499 nefit n $2,000 for Research I $500–$999 nstitute me and my $1,000–$1,499 , Novem $1,500–$1,999 b family er 2009$2,000–$2,999 b). $3,000 or Don't Know Figure 39, Following Treatment Rpublic egimens polic for Five Mos y research and t Preval education on ent Chronic econom Dis ic se ecuri ases ty , 2009 and em ................................. ployee benefit issues. 35 compare 11 develo perc d wit pe ent h four d adi b HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. d not contr udg earet to m lier annual ibut ana ege survey anythi healt s. ng. h car e expenses; checked prices before getting care; and used an online cost- their extremely or v deducti bb ble e appli ry importa ed to al nt l hea that their lth cadoct re se or understood them rvices. as a person, with the difference between traditional plan traditional plan enro Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. 1988 1989 llees1990 to take adva 1991 1992 ntage of 1993 1994 the 1995 hea 1996lth 1997 risk assessment an 1998 1999 2000 2001 d partici 2002 2003 pate 2004 in t 2005 he he 2006 alth 2007 promotion 2008 can use to Partic bpa Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. y for m Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. ipating in edica Program, 2009 l expenses or th ................................................................................................. e ability to take their account with them should they change jobs. I ................... ndividuals 16 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. expenses (32 the benefits ar perce e not Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. n justifie t CDHP d vs. by $200the costs (Chernew, 15 percent traditional et al., 2007). ); checked the price of service before gett Moreing care (35 percent However, it is HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. standard pract Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. c ice among employers that an employee must also choose a high-deductible health plan in could s 22 percw ent r itche benefits, cost was unc porting it han as a ge manage dmajor reason from 20 ment 08, with , worker a and 64 32 percen perce nd nemploye t of t re tradit portir n attitude ion g it a al, 4 s a minor 9s, policy reform p perce reas nt of CDH on. Forty-six P, an ropo d sals, and p 38 percent percent o did no en f s HDHP ion asset t s traditional of-network ser cove v arage ices. to An have individual a choice can EBRI’s member of hav health e a healt plan, ship includes a hfollo plan wed by withcross-section of a those deductible enrolle an pension funds; businesses; trade associations; d d ma in HD xiHPs. Seve mum out-of-pocket limit nty percent of tha CDtHP at least $5 0,0 My deductible is $2,000 00 co a CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. ntributed $2,000 or more to t or more for me and my f he account, whereas amily 13 percent of those with household income of CDHP enrollees were more li c c a a kely than traditional plan and HDHP enrollees to use information provided by their health a Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). c a aTraditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). a CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. 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). tracking too CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). l. programs. and CDHP enr In CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). o additio llees statistic Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). n, finan acial in lly sign centives ificant. Abo mattered mor ut two-thirds e to C ofD in HP divi enr duals, r ollees tha egarn d to less of plan traditional type, t plan enro hink it llees. is extreme ly Figure 40, Access Issues, by Type of Health Plan, 2005–2009...............................................................................36 with only a flexb ible * Difference between HDHP/CDHP and Traditional is statistically significant at p spending account (FSA) were not included in the CDHP = 0.05 or better. group. and fundi b ng. There is wi labor un despread ions; health recog care prov nition that if employee be iders and insurers; government org nefits data exist, EBRI kno anizations; and service firms. ws it. CDHP vs. 2 order to have 5 b percent an HRA. b traditio nal); and used an online cost-tracking tool provided by the health plan (24 percent CDHP Figure 13, Perce b HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. ntage of Individuals Reporting That They Would Probably Participate in Employer Wellness enrolle Fronstin, participes e ate Paul, x because th * Difference between HDHP/CDHP and Traditional is statistically significant at p tr b emely or and Sara a b b ey were alr very R. C likely to stay ollins. “Fin eady hea din with t g lthy (17 percent report s From th heir pla e n20 if07 EB they RI/Com had th = 0.05 or better. ed it e opportun as a major rea monwealth ity Fu to switch s nd Co on and nsumeri pla 29 n percent r s. sm in Hea eported it as a lth quali enrolle fies es ha him o * Difference between HDHP/CDHP and Traditional is statistically significant at p d HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. Don’t know amount of family deductible a choice r her 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. a to make of heal a tax th plan, compare -free contribution d with 60 to an perce HSA, but th nt = 0.05 or better. of ine diindivi viduals dual in is n tradoitt require ional plans d to , amake a co nd 51 percent ntribution of ENROLLMENT plans. less than About $5 * Difference between HDHP/CDHP and Traditional is statistically significant at p 0, 6 in 000 LOW BUT GR 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 contri Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. 0 CDbute HP OWING enrolle d $2,0es in 00 : In 20 or m dicated t 09, ore to th 4 h perce at th e ac nt ey cof the had made ount. po = 0.05 or better. pulat use of ion was the in enroll formeation a d in a CDHP, bout the up quality from 3 of per their cent in • In 2006, th 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), with account. e s HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. urvey found that individuals in CDHPs and HDHPs were less likely to be satisfied with the quality of CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. Table of Contents c or very import c ant that c c their doctor coaches them about staying healthy rather than just treating their health problems. This Issue Brief ^ Difference from prior year shown is statistically significant at p c presents findings from the 2009 EBRI =/M 0.05 or better. GA Consumer Engagement in Health Care Survey. This study is ^ Difference from prior year shown is statistically significant at p Source: Mercer National Survey of Employer-Sponsored Health Plans and Bureau of Labor Statistics. c CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. c a = 0.05 or better. ^ 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. c 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. = 0.05 or better. vs. 12 Health Status and Demographics perc Program, by Various Financ ent a traditio * Difference between employee-only coverage and family coverage is statistically significant at the p CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. nal) (Figure 5). ial Incentives and Type of Health Plan, 2009 = 0.05 or better. .................................................17 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 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. = 0.05 or better. minor reason Survey.” ). There were EBRI CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Issue Brief, no di nofferenc . 315 (Emplo es in th yee B e ane swers to this series of nefit Research Institut qe, March uestions 2 b008 y plan ty ). pe. or open an ac those wit Don't know if have deductible h a H count. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. DHP (Fi gure 22). These results are in contrast to findings from 2005 and 2006, when individuals with 200 doctors, compared • 8. Enrol care rec Individuals #lm Difference between 2005 and 2009 is statistically significant at p ee ived nt i were more likely n HDHPs than those in with less increased than t raditiona to report 50 perc from ent amon l that 11 plan p e they ha s, but rcent g tra in duri =d d 0.05 or better. itional 200 prov ng 8 to 200 idplan er 13 7– qual 200 an pe ity in d HDHP rcent i 9, thfis gap in ormation tha n enroll 2009. satisf ees. Cost Thn e 4 cost inform action perce info betw nrmation t of t ee atin those on, an he was u popd HDH ul in a sed tion P by # Difference between 2005 and 2009 is statistically significant at p * Difference between HDHP/CDHP and Traditional is statistically significant at the p * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. = 0.05 or better. = 0.05 or better. It is not clear from the data whether the differences in consumer engagement can be attributed to plan design Individuals # Difference between 2005 and 2009 is statisticall we * Difference between HDHP/CDHP and Traditional is statistically significant at the p * Difference between HDHP/CDHP and Traditional is statistically significant at p re as * Difference between HDHP/CDHP and Traditional is statistically significant at p * Difference between HDHP/CDHP and Traditional is statistically significant at p signed to the HDHP group i y sigfnificant at they did p = 0.05 or better. not have = 0.05 or better. an = 0.05 or better. = = 0.05 or better. 0.05 or better. account used for health care expenses with a * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. based on a And a bout on n o * Difference between HDHP/CDHP and Traditional is statistically significant at p e-thir nlined o survey o f individuals f 4,22,6 rprivate egardles ly insure s of pla dn t ad yul pe, th ts ages ink it 21– = is 0.05 or better. extr 64 to provi emely or de na very importa tionally repres nt that th entative eir do data ctor us e HRAs are ty EBRI delive pically set rs a stead up as notional y stream of invaluable research and anal EBRI’s work advances knowledge and unders arrangements and exist only on paper. Employ tanding of emplo ysis ees may viyew ee benefits and their the account as if Introduction................................................................................................................................................................ 5 Individual contributions to the account also vary by whether an individual has single coverage or family coverage. Figure 21 contains data on various demographic and health status variables from each of the surveys conducted traditional Figure 14, Importance of V coverage were mo are likely to rious Provider Engagement Tools, by have a choice of health plan t Type of Health han individuals enrolled Plan, 2009............................... in CDHPs (Figure 23). 17 with 36 perc a CDH ent o P r f e HDHPs enrol presents 5 million lees, 41 adu percent lts ages 21 of tra –6 ditio 4 with nal private plan enrol insur lees, an and 54 ce, whilpercent of CDHP e the 13 percent en wirollees. th a HDHP CDHP traditional enrollees w pla ere n less like s and those ly tha with C n traditional DHPs di pl sappear an enrolle ed be esc t aus o report e satisfacti that t on incr he plan eased signi provided cost or ficantly qua among those wit lity h differences or whether various plan designs attract a certain kind of individual. Regardless, it is clear that the importance to the nation’s economy among policymakers, the news media, and the public. It rollover provision or portability if they changed jobs. This group includes individuals with HSA-eligible health plans but medical termi n EBRI ology duripublications ng patient-provi inclu dde in-de er discusp sth cove ions. rage of key issues and trends; summaries of research regar money w ding th as ac e growth tually bein of acc g deposited into ount-based he an accou alth plans a nt, but em nd high- ployers deducti do not ble health incu pla r ex ns pe (HDH nses associated wit Ps), and the impact h the of these Summary of Findings................................................................................................................................................. 5 Taylor, Hum phrey. “Does Internet Research ‘Work’? Comparing Online Survey Results With Telephone Surveys.” Both individuals and employers are allowed to contribute to an HSA. Contributions are excluded from taxable income if Health Care Us Speci 3. Do you have a specia fically, individuals w e an ith d Access Issues single l account or f coverage are und you more lik can use to pay for medical expenses? The accounts ely than those with family coverage to contribute less than The betw survey als een 2005 and o foun 20 d t 09h. at t Thhese e perce data ma ntage y ex of plain indiv some of iduals in a the CDHP differ wit ences i h a cn h oice beha of vior and attitu health plan gr des that ew from were 47 pe observed rcent does this by conducting and publishing policy research, analysis, and special reports on represe enrollees an CDHPs. information. nts 1d 6.2 mill The HDHP enrollees we gap i There ion n peo w satisfacti as no ple. Amon dif re on rates more fere g t nce h li ekely than for 16. in tquality of h 2 mi e perce llion tradi i n care n tage tional divi r of C duals eplan maine Dwit HP enr d hand bet o an llees to w HDHP, traditional een tr try to 3 aditio 8 percent pla fin nal n d enro enroll informati (or llees ees a 6.2 mi re on on n porting th d HDHP llion cost an ) reported e d under What we do lying characteristics of the populations enrolled in these plans are different. Adults in CDHPs were significantly may also inc Figure 15, Likelihoo lude finding indiv d of Ch idua s and ls angin with policy develo high-de g Docto ductibl r if Cost Sh pments; timel es whoa a rire no ng wa y factsheet t eli s Lo gible we s r Wh to contribute t on hot topics; en Usingo Docto regula an HSA. rs Wh r up Inda di oviduals Use tes on legi HIT and withslat ive and Cost-Conscious Behavior ........................................................................................................................................ 10 plans a nd consumer engagement more generally on the behavior and attitudes of adults with private health insurance arrangement until an employee incurs a claim. By contrast, were employers to set up the HRA on a funded basis, they International Journal of Market Research. Vol. 42, no. 1 (August 2003). made by the employer and deductible from adjusted gross income if made by the individual. The maximum annual $1,0are sometimes referred t 00 to the account, whereas in o as Health dividuals with Savings Accounts (HSAs), Health Reimburseme family coverage are more likely than those with single covera nt Accounts ge to employee benefits issues; holding educational briefings for EBRI members, congressional and between traditional plan enrollees, HDHP enrollees, and CDHP enrollees, as presented in Figures 5–19. In 2008, adults to 70 percent between 2005 and 2009. This may be due to the simple fact that an increasing percentage of the CDHP that they quality from s were o eli urces other gible for a t hhealth an the h savings ealth pla account n. Specific (HSA Fially, 2 ) gure 5 but di 8 d not perce h na t of ve such CDHP an ena rollees a ccount. nOvera d 24 perc ll, 11 ent o .2 mfillion HDHP enrolle availabil Current Doctor Does es. ity of Th regul e d cost and iff atory de erenc qua es i velopment Not Use HIT, lin ty informatio overall satisf s; comp by Type of Heal n. In action l re terms o hen evels sive refere f buse of yt plan h Plan, info type fo nce resou 2009 rmaund in tion provi .............................................................. rces o all n benefit pro d prior ed by he years of alth grams an the plan s s, CDHP urvey w d wo e were rkforce re 19 less likely to The survey as hked r ave a espon healtde h problem t nts who ha han d c w hronic co ere adults nditi in H ons DHP whs or tra ether th dey a itional greed t plans. hat they Adults in CDH carefully follo Ps and HDHPs wed their were Trends ................................................................................................................................................................. 11 traditional health coverage include a broad range of plan types, including health maintenance organizations (HMOs), coverage. would incur t Th he sampl e full ex epense was randomly at the time dra of wn the contr from Syno ibutio vate’s onli n, even i ne f an panel o employee f mor ha e th d an not incu 2 million rred a Internet ny expenses. users who federal agency staff, and the news media; and sponsoring public opinion surveys on employee (HRAs), Personal care accounts, Personal medical funds, or Choice funds, and are different from contribution is $3,000 for self-only coverage and $5,950 for family coverage in 2009, increasing to $3,050 and $6,150 contribute at least $2,000 (Figure 30). Overall, 25 percent of individuals with single coverage contributed at least popul in CDH ation Ps wwo ererks for an significan em tly ployer more like with ly to 500 self-re or mor port e em bei ployees, as ng in excellent shown in or very Figure good21. health, than those with HDHPs or issues; and major surveys of public attitudes. adults a Cost-Sharing Incentives Availability and Use of Cost enrolle unchan more like es sought other ges 21 gel–64 y th d in wit an traditional the 2 h sourc priva 009 surv e t and Quality In e insura s of plan ey: Tra informati and HDH nce, r ditiona on, wh eprese formation P l pla enro ile nting 8. n 17 e llees n ........................................................................... percent rolle to 9 percen es wer have reported that t of tra te of t mor dih tional e at market, likely than plan h enr ey ma were CDH ollees de either P and HDHP use of did so. in a th CDHP e i en nformation. ................... rollees to or were in be an 11 Cost-Conscious Decision Making, by Type of Health Plan, 2009 signific treatment r antly ele giss likely to sm mens for specioke than fic conditio we ns. re adu Thlere ts in w trad as n itoional signiplans, a ficant vn ariation i d they were n the signific frequency antly m with w ore like hichl peo y to ple with preferred provider organizations (Pbenefit issues. POs), other ma EBRI’s Ed naged care ucation and Re plans, and seplans arch F with und a (EBRI-ERF) performs broad variety of cos the char t-shari itable ng , Figure 8 have a Figure 16, Likelihood of Choosi greed to participate in researc ng Doctor by Their h surveys. This sur Use HIT, by vey used a Type of Health base sample of Plan, 2,0072009 to draw i ................................... ncidence rates for 19 employer-provided Flexible Spending Accounts. in 2010. $2,000, while 42 percent of those with family coverage contributed at least $2,000 to the account. EBRI meetings present and explore issues with thought leaders from all sectors. traditional health coverage, but the difference in self-reported health status in 2009 was no longer statistically Participation in Wellness Programs......................................................................................................................... 11 HDHP that was eligibl Percee nt for age of an pr HSA, ivatel but y inha sud not red adu ope lts n ae ge d sthe acco 21–64 wh unt. o received health care in last 12 months extreme CDHP and HDHP enrollees ly or very satisfied were also more likely to try wieduca th the tiona overal l, and l plan scientif in all y ic func t eo ars of the survey. Differences tifin ons of the Instit d information abo ute. EBRI ut cos -ERF t and quality o is a tax-ex in satisfaempt organization ction with out f their doctor -of- exercise. chronic co ndit Peop iole ns follo in CDHPs wed t were heir tr also l eatment ess likely regimens ac to be obrese com oss plan ty pare pes d w , with ith adults one e enrolle xception: d in a CDHP traditiona enrollel h es w ealith pl th an. HRAs can be thought of as providing “first-dollar” coverage until funds in the account are exhausted. Leftover funds at arrangem ents. The shared characteristic of this group is that they either have no deductible or deductibles that are persons with a Questions were ccount-based first asked in 2008 a Sources of Information for Health Plan B health pla bout ns a cost-sharing v nd HDHPs, an ariations as a d the base samp n ince le was ntive com regardin enefits, pleme g cho nted wit ice of provi h an additiona der, but 2009 l When i Figure 17, Intere ndividu als have EBRI regula st in Usi a cho ngi Select Networks Comp ce of h rly provides ealth plan, th congre ere ssion are osed al testimony many reasons of Only Medical Provid , an why a d briefs p n indivi oers licy dual may m With Record akers, mem choose a s of Providing ber o partic rgaular nizations, Opinions About Pr When it comes to sources of ovider Engagement information a ............................................................................................. bout the health benefits offered by the health plan, the majority of ....................... 14 supported by contributions and grants. significant because of a slight (but not statistically significant) increase in the percentage of traditional plan enrollees pocket costs from sources may ex other tha plain n th a esignific healthant plan. portion of the Figure 20 difference in overall satisfaction rates between traditional Adults in allergies the end of eac CDH wereP h less likely t s wer yeare can signif be han icantly more carried over to traditional lik pla ely than the follo n enrollees those win wit g with year (at th h all tra ergi deition s to e employer’s afl hea ollow t lth cov heir disc tre erage to retion), atment re have allo gime wi ang high n (Fi employees househo gure 39). lto d below current thresholds that would quality for HSA tax preference, and that they do not have an HRA-based plan. Endnotes To be random ov eligibl Yes ersample e for an of t HSA, i hesne two dividuals may groups. More specif not be enrolle ic Figure 16 Figure 14 Figure 35 ally, d in Figure 23 other h the overs eal amples were: th covera 50% ge, s 1) uch as a those with either spouse’s pla an nH , u Rnless that A or an Concerni marked t Checked whet ng le he firngth her pla st year that and the medi of t n woime t uld c questions were ov hat CDHP er a on employe enroasked regar llees h r benefits. ave hd aFigure 12 Figure 18 Figure 31 Figure 29 Figure 37 Figure 33 Figure 27 Figure 25 id n Figure 2 g thhe eir acco alth inun fot, 8 rmation tec percent he nn orolle logy d in (HIT). the past six mo CDHP enrollees were nths, High-Quality Care Combined With Lower Cost by Type of Plan, 2009 Figure 39 Sharing, by Type of Plan, 2009 ........................................20 health Cost-Sharing plan. Whe Incn entives asked a ........................................................................................................ bout the main reason for enrolling in a plan, 47 percent of CDHP en .................................. rollees reported that 14 MORE CO respondents, r ST-CONSCIOU egardless of pl S BEHAV an type, repor IOR : Individuals i ted that th n Cey r DHPes wer ceivee d more that in likely th formation an tho in a pri se with tra nted ha ditional covera ndbook or bookl ge to et. reporting they were in excellent or very good health, combined with a slight (but 56%* not statistically significant) decrease in Figure 4 Percentage of Adults Whose Deductibles Apply plan, HDHP, and CDHP enrollees. Figure 10 income. Generally, t CDH he P200 and HDH 9 findin Pgs enrollees are in contrast were also more l to somew ikel hat y th mixe an tr d fi aditio ndings nal in plan 2007 enrol (Fron lees to stin and be hi Coll ghin ly educate s, 2008).d I . n 2007, accumulate funds over care time, and, in principle, creating the key a incentive for a individu 61% als to make * health care purchases plan is also a No high Importance of Various Provider Engagement Tools, by Type of Health Plan, 2009 E -B deduct Percentage of Individuals Covered by Employment-Based Health Benefits RI issu ibles pre e he Likelihood of Choosing Doctor by Their Use of Health Percentage Extremely or Very Satisfied With Overall alth ss rele plan. as However es on ne , wsworthy developm individuals are allowed to h ents, and i ave supplem s among the mo ental coverage wit st widely qu hout a oted another Health Plan F HSA, and 2) t found to 20 percent i be mho eatures ose wit re like nl th h y tha Percentage Extremely or Very Likely to Recommend Health Plan to and Demographi a Reasons for Not Participating in Employer's Wellness Program e H pa Likelihood of Changing to Select Network if Current Doctor n D traditio st year, an HP Distribution of Individuals Covered by Private Health without Annual Individual Contributions to the Account, Annual Employer Contributions to the Account, nal Amount Rolled Over from Past Year, 2009 d pla a cs 36 percent nn account but .......................................................................................... enrollees in to th with re e port t pa de st two ducti hat th y be le ey were ars (Fi s that ar gure 31). extremely or v e generally One-quart high ery li en er (26 percent kely to ch ough ..................... to m ange eet) the report 18 Following Treatment Regimens for Five Most Prevalent Chronic Diseases, 2009 Percentage of Individuals With Traditional Length of Time With CDHP EBRI Issue Briefs are periodicals providing exp and Savings Account, 2009 Employment-Based ert evaluations of employee benefit issues and they enrolled because of the lower premium, while 47 percent reported that the opportunity to save money in the exhi Speci 70% bit a f ically, num 60 ber o percent f cost-co of trn aditional scious be plan havi ors. Th enrollees, 5 ey w 9e pe re more rcent of likely HD t HP enrol o say that t lees, hand ey had check 56 percen et of C d whether DHP the enro plan llees Figure 18, Likelihoo • When asked about sourc d of Changin es of in g to Select Net formation on the work if benefits offer Current Doct ed by t or wa he health s Not in Select Net plan, the majority work, by Type of of respondents, the percentage of CDHP enrollees r Familiarity With Consumer-Driven Health Plans, 2009 eporting they were in excellent or very good health. However, the survey also to All Medical Services, by Coverage Source, 2009 Because the base sample Employer Offers Wellness Program, by Type of Health Plan, 2009 (national sample) included onl a y 94 individual 46 s in a % CDHP and 262 individuals with a HDHP, an 1 people responsibly. Asked fo in CrD g E H eneric drug in P m s with ployers can sour arthrit ces o stead n iof place restrictio s e and hyperte mployee ben ns on th nsion w efits by all media. ee amo re significant unt that ly less l can be carri ikely to say t a ed over. hat they a followed their treatment Not sure Percentage of privately insured adults ages 21–64 with chronic conditions who Calculated from Health Status Figure 1. and Dem With a Choice of Health Plan, by Type of Health Plan, 2005–2009 Information Technology (HIT), by Type of Health Plan, 2009 ogr (Among Persons With CDHP aphi Health Plan, by Type of Health Plan, 2005–2009 cs ................................................................................................. Who Have Had Account More than One Year) b c ...................... 18 high quali-fdeduct ying thr ibl ee s for hold to m such ta Among Those Offered but Not Participating in Program, 2009 hin keFriend or Co-Worker, by Type of Health Plan, 2005–2009 tax- gs as vision Was Not in Select Network, by Type of Plan, 2009 pre Insurance, by Type of Health Plan, 2005–2009 trends, as well ferreca d contributio re, dental as critical analy care ns to , speci such a ses of fic n acc emplo disea o ys unt. Hi ee benefit po es, and gh insur dlicies an educti ance t b d proposals. les hat were pays de a fi EB fin RI Notes xed amo ed as is a unt bein doctors if g in th cost sharin e account thr g was l ee to four ower whe years n using a , and 9 doctor percent wrh 11 eo use port havin d HIT. g t h Thirty-o e account ne per forcent of five years or CDHP more. enrollees would Our by Household Income, Among Persons With CDHP, Among Persons With CDHP, 2009 52%* 2009 account for future years was a main reason for enrolling in that plan (Figure 24). Among individuals with traditional Plan, 2009..................................................................................................................... (Percentage of privately insured adults ages 21–64, who have a deductible) Health Benefits Offered HDHP or CDHP, 2009 ...............................20 would cover receive • As befor regar d print dless of ce ed informatio are; asked for , this year’s surv plan type, n a re (Figure 8 gen ey ported t finds eric )dru that i . (Percentage Reporting Extremely or Very Important) h at th H go inste wever, indivi nedi y receive viduals i ad of a d n brand nam d t C uals hD atH informat iP ns and HDHPs CDeHP ; talked to s were ion in a wer much the print e iboth r ed ha more like doctor a les ndbook s likely th b ly th out or an those prescript boo an t kh let. Ho ose in in t ion ra drwever d ug itional , asked respondents whether they had chronic conditions. Unlike the lack of differences in self-reported health status, As the CDHP and H brand name d DHP markets continue rug strongly/somewhat agree that they follow their treatment regimens very carefully to expand and more enroll aees are enrolled 56%* b for lon c ger periods of time, the oversample o 70%f individuals with a CDHP or HDHP w 14 as added. The oversample included 879 individuals with a CDHP and 60% EBRI directs members and other constituencies to the informatio 5 n they need, and undertakes new regime Trends ns for ......................................................................................................................... their conditions carefmonthly ully. But period peopical providing cu le in CDHPs with rrent information on a variety depression were significantly mo ........................................ of employ re like ee bely to say nefit topics. they 22 60% 40% per day (or 75% ot 59% her perio d) for hospitalization. Individuals enroll Traditional ed in Medicar HDHP e are noCDHP t elig ible to make HSA indivi change to dual deductibl doc 80% tors who es of used HIT at least $1, Extremely or Very Familiar in r 00 esp 0 a on nse to lo d family wer co deductibl Somewhat Familiar st sharing, es of at l co empared with o ast $2, Not Too or Not At All Familiar 000. The ne-quarter final sam of ptraditional le included pla 972 n in 40% 100% 80% 60% 30% ab c health 60% covera 100% ge, 40 percent cited the good network of providers and 35 percent report the low out-of-pocket costs as options 2plans to, receive in other treatments formation , a n about t d costsh;eir as 55%^ he ked th alth eir bene doctor fits eto recommen ither through da Web site or a less costly pres via e-m cript ail. ion O dr nug; e-half develo (49 pe ped rcent) a traditional individuals pla in CDHPs w ns to recomm ere much more end their h lik ealt ely than h plan to those a fri in tr e 35 nd or co % aditio-wor nal plans to ker and l rece ess li ive in kely than formation thos e w about t ith tra heir ditio nal the survey sustained impact that these found t resea 56% hat i n rch on a dividuals in plans are having n ongoi EBRI’s CDHPs You can make changes on your own ng ba Pewere sign nsion Inv on cost, sis. eifica sab tme quality, an n nt Re tly less lik port d acc provides detailed fin ely e 26% ss to health to have ca h ca ea al ncial re services th pro 33% information on th blem th wilan w l be better 59% e e universe of re adults in Dis Figure 19, Agreem More informatio Tal tributio ked tons doc ftor ab rn about HRAs an om an H out pres ent With RA f criptio o Statement r qua d HSAs can be found in the defini n lified m s About Propo edical expenses sed Way are m tions section on pg. 39 as Traditional de to Engag on a tax- e Co favore and in F HDHPnsu d ro m bas nstin (2002 and ers in Mana CDHP is. Employers 2004). ging Health Care can also let 1,34 Choic 0 i en of Health Plan, Premiums dividuals with a HDHP, resulti , and Reas ng in a tota ons l samp for Choos le (base ing pl Plan us ov ................................................................. ersample) of 972 for the CDHP group and 1, ..... 60 22 3 publications 53% 92% follow Concerni ed their ng ac count balanc treatment regi e,mens care 6 percent had fully than no balanc did th e w ose w hile 20 2005 ith tra percen d 42%* 2006 itional covera t had $ 2007 3,00 ge. 2008 0 or more 2009 (Figure 32). Overall, 2005 Traditional2006 2007 HDHP 2008 2009 CDHP 52% 36% HDHPs wit contributioh n either an HSA s, although they or HRA are a 60%*b(con le to wit sumer-dr hdraw mon iven 36% he ealth plans, y 36% from the HSA or CDHPs), 1,6 for qualified m 03 in high-de edical expenses and certa ductible 60%* 70%*^ health plans in enrollees (Fi 100% gure 15). 89% Less than $200, 4% the main reasons for options and cosenrolli ts ng in the plan. ab c 44%* 87% defined benefit, defined contribution, and 401(k) plans. EBRI Fundamentals of Employee budget of CDH plans to health to ma P enroll Communicates with you so that you be stay nage ne ees rec fit EBRI maintains an hea with t s either elth c ived i heir throu are e curr nformation x g ent h penses; checke h a d analy Web site ealth about their pla ze n or via e s the mo if d they pric he58%* alt e - ha mail. sst comp be h pl d t for an he o CDHP eben gettin re pportu hen e an fitg ssi d HDHP enrol car via a nity ve databa e to switc ; an Web sit d used a se h le ees plan , compar of 401(k) n were also mor s. online ed -type cwith ost-tracking to prog 34 percent in e likely tha rams in the ol. n HDHPs or tra Contribution Behavior Costs, by Type 60% 90% ditional plans: an 67% of Plan, 2009 d Account Balances 46 perc 86% ent oab ................................................................................................... f those in ..................................................................................... CDHPs reported c a chronic health problem, compared with 52 percent .................... ...................24 21 understoo employeesd. T us 70%e an he five y HRA to 49%ears purchase of consumer 49%^ healt ehn insura gagement nce su directly rveys reporte from an insurer. d here provide Since un a uni usque ed fu basel nds are al ine 87%from lowed whic to roll h to for the HDHP 15 group. After factoring out o Traditional 66%^f the base sa HDHP mple CDHP the 94 individuals with a CDHP and the 262 individuals with 34% 6 35% 56%* 49%* 84% Offered CDHP, 14% 56%* Whil 44 perc e pane ent 35% 50% l I hand less than ternet surveys are $1,000 in the ac non-random, studies count at Don't Know, 7% the time have de of the surv monstrated t ey, an hd 9 perc at such surveys, wh ent did not k en now ho carefully w mu designe ch was i d, n 64%^ Traditional You do not have enough time to participate HDHP CDHP 22% 32% 3premiums. can really understand what they are Individuals also may not make an HSA contri 2005 bution 2006 if claim 2007 ed as 2008 a depenab 2009 dent on a 25% noth 55% ec90%* r person’s tax without accounts (HDHPs), and 1,6 63% Benefit Programs 51 in more tradition Total offers a straightforward, b <$50,000 Income al health plans.$50,000+ Income asic explanation of emplo 63%*^yee b 63%*enefit programs in 33% 88% See 50% www .mercer.com/summar worl 62% d. Its co y.htm?idContent=1 mputer simul328445 ation analy ses on Social Security reform and retirement income adequacy Talked to doctor about treatment Satisfaction a traditional plannd Atti s. Simi 61% tudes larly, ..................................................................................................... 43 percent of CDHP enrollees received information via e-mail, compa ................................... 48% red w45%* ith 27 percent i24 n traditional 50% 25% plan enrollees to prefer to receive information through e-ma Traditional il and a Web s HDHPite. CDHP among t measure In 2007, th hfutur ose i e se u n cha rvey fo traditional nges und t in t 60% pl hhis evolvin ans and 54 at adults wit 60%^ g ty percent amon h CDHPs pe of he and althg in HDHPs HDHP enrollees. surance. were significantly more likely to r 52% eport that th 90%* ey had over, employees are able to accumulate funds over time. Employ 37%ers can allow former employees to use any leftover a HDHP, there are 1,651 in 51% saying dividuals in the sample 51% with traditional health coverage. 84% Figure 20, Perce 80% ntage of Adults Whose Deductibles Apply to All Medical Services, by Coverage Source, 2009 ..21 the acco CDHP enunt. rollee Concerni s woul a d also ng rol be more lovers, 10 the priv likely per t at cent roll h e and an tra public s d ed ov itiona er elctors pl noth an . e The ing w nrolle EBRI Data hies to switc le 41 $200–$499, 7% perc book on Emplo ent r h doc otlled over at ors to one yee Benefits 83% wh least $1, o used e is a 00 stat - 0 at mail istic the al to obtain results comparable to random-digit-dial t 50% elephone surveys. Taylor (2003), for example, provides the results 60% 43%* return. Among the opti 60% po ons pulation and costs with traditional coverage and a choice of plan, 40%* 39 percent were offered a CDHP or HDHP, and CDHP MORE E Traditional NGAGED are uni 9% IN que. WELLNESS PROGRAMS 16% 56% : CDHP enrollees were more 69% likely than traditional plan enrollees to Health Care • There was no Use and Access Issues significant variation in .............................................................................................. the frequency with which peopl 80%e with chronic conditions follo ......................... wed their 28 48% 48% 55% 50% Don't Know if CDHP or HDHP 44% traditional pla 75%ns. Few people You do not need it because you are already healthy 54%^ receive information in person, by telepho 17% ne, or in ot29% her ways, an 46% d the differences by plan 39%*^ money in avoided, skippe the 30% HRA to conti d, or delayed he nue to alth care cover qu because o alified mefdic cost al ex s than penses. were those with Funds can be us 77% more traditio ed for out nal co -of-pocket e verage. In xpens 2008, es and 4 30% Works with you to find realistic reference work on employee benefit programs and work force-related issues. www. 52%* a ebri.org 75% 38%* Findings from this survey are compared with findings from the 75% 2005, 45% 2006, and 2007 EBRI/Commonwealth Fund from a end deliver See of www la 20 num b t .h 08 ealthcaredisclosure.org/ 40% be e (Fig sts, allowe r of surv ure 33eys th ). d t 39%* he in at wer dividual e co to schedule nducted at the appointments on same time 34% usin line, an g the 51%* same d answe que red stionnaires patient Tradi qu bo estions via e tion th via t al elepho -mail ne and Was Offered, 27% 74% 34 perc Asked doc ent we tor re not to recomme offend red lesit, but s 27 percent did 41%* not know if they w 50%*ere offered it (Figure 25). Among the 39 percent Conc Figure 21, Selected 40%lus ion70% ..................................................................................................................... Demographics, by Type of Health Plan, 2005–2009 ............................................................ .......................................... 49%* ...31 23 report t • treatment r CDHP e hat th ney ha rolle egi ed th s men across were e o more pportunity pl lian types, wit kely than to fill out a tradi h one h tional ealth exc plan risk eptio enr assessment, wh n: CDHP ollees to e repor nrollereas t ees t that they ha with hey w allere gre ies d equall th were e opportu y likely to less likely nity to re than port that fill out a Adults in CDH changes you can make to improve Ps and HDHPs were also significantly less l 72%ikely 72% to smoke 39%* than were adults in traditio 77% nal plans: 13 percent 75% In ad type ar ditio e not n to statistically significant. being stratified, the b aTher se sa e was mple a si was a gnif lso we icant diff ighted by erencegen , ho dwever, er, age, in e the ducation, perc 47%*^ enta regi ge of 63% on, income, responde an nts d 50% 47%* HDHP enrollees continued to be more likely than traditional 2005plan enrol 2006 lees to r 2007 eport 34%* 2008 that they 2009 had delayed or avoided premiums for insurance, long-term care, COBRA, and retiree 46%* health benefits. Employers are not required to make 26% Individuals cost 50% 40% lwh y pro have reach escription drug ed age 55 and are not yet 45%*enrolled in Medicare may make catch-up cont 76% ributions. b In 2009, Consumerism (Figure 16). 20% Overall, a in Healt your health h34% b Car out e 60 Survey, percent You just do not know enough about the program and t of CDHP he 200 enrol 8 EBlRI/MGA ees, and 5 Consum 39%* 0 6% perce ent of r Enga 26% tra geme ditio nt nal in H plans ealth enr Car ollees, e Surv woul ey. d Past change Appendix— online. He fo M und that t ethodology he u ........................................................................................................... se of demographic weighting alone 44%* was suf 32%* ficient to bring almost all of .............................. the results from the 37 EBRI makes information freely available to all 32% who were offered either a CDHP or HDHP, 14 percent were offered a CDHP, 13 perc 58% ent were offered a HDHP, and 13 they had access to a health promotion program. CDHP enrollees were more likely than traditional HDHP plan enrollees to traditional health 40% risk assessment, wh plan enrollees wit ereas they h all 57%* ergi 31% e wer s to e fo e llow t qually heir likel tre y to re atment re port tha gime t they n. Gen had acc erally,e these 2 ss to a h 00 ealt 9 fin h promotio dings aren in of those in 5 CDHPs and HDHPs smoked, compared with 18 percent of 56%* those with tra 41%* ditional cov 30%* erage (Figure 21). Figure 22, Perce 25% 60% ntage of Individuals Covered by Employment-Ba 40%*^se 40%* d Health Benefits With Choice and No race/et reportin hnicity g that to refl they did ect th note get in actual formation Contact EBRI proportions in t about Publications, (2 their he population plan benefits. 02) 659-0670; age 21 HD –64 HP enrollees were most li wit fax publication h private health orders to insur kely to report ance cove (202) 775-6312. rage not . See Appendix f 25% or more detail on the methodolog 23% y. 23% 23% unused ba getting any n lanc ees availa eded health ble to care services workers wh because o en they leave. f costs, but the difference between traditional plan enrollees and 15% $2,000 or More, 22% 28%* Definitions reports use a $1,00D 0 catc evelop Takes responsibility for coordinating 30% d .................................................................................................................... EBRI assume “Compreh ed bud h-up contr get to 60% ensiv manag ibuts a publi ion w ee” asa the s allo c descriptive service re wed. The spo label catch nsi fo bility to - 37%* up co r what ntributio is no make its finding w n is not labeled more ins co dexempletely acce “Traditio d to 37%* ............................................ inflation. nal” h e ssi alth ble at plans. www.ebri.org A label 39 online doctors to tho survey 40%close to th se using HIT e r f eo plies r lab tests, o from the nline paralle appoint l teleph ment one survey. s, and e- H mail consultat e also foun $500–$749, 15% d t ions. T hat in h some c ere was no diff ases propensit erence by y You are uncomfortable participating in this kind of program with your 51% 51% 27%* 74% c 12 perc 30% ent were 40% offered an HDHP and did no 58% t know if they were offered an acco Offered HDHP, 13% unt. 50% 41%* 27% 18%* 35%* partici contrast to so program. pate when HDHP enrol a mewhat pro49% gram was mix lees ewere less lik d f offered. Among Subscriptions to indings in el2y to report ha 007. EBRI those not In Issue Bri 2007ving ac p , peo arti efs cipati p are included le cess to in n CD g, th a h HPs with ey as part of ealth did n pro arthr ot partici EBRI motion pro itis and membership, or as part of pate hyp g because they raem. rtension When it were could co a mes People inChoi CDHP ce of Health Plan, by s were also more likel Type of Heal 56% y to 56% exerciset an h Plan, 2009 d they were ............................................................................ less likely to be obese compared with adults enrolle .....d 25 31% 48% 25%* 9% 20% 30% CDHP The having rece CDHP an ive d HDHP ov d information 55% ersamples (11 perce were nt), w e compare ighted by 33%* d wit geh nd 8er, percent age, inc am ome an ong tra d rac ditioe/ethnic nal planity, enrol usin lees, an g the d demogr 4 percaphic ent hea your care with other providers, lth care expenses 76% CDHP disappe 50%ared, mostly because of the significant increase 32%* in the percentage of 20% traditional plan enrollees reporting Health Saving Orders/ s Accounts ........................................................................................................ coworkers ............................ 39 50% — so that all decisions that relate to emp 23%* loyee benefits, whether made in Congress or board rooms or change plan type wh was a en it c ppropame to riate giv al elowin n that g these patient plans ar s to request a e not as co nd re mpreh ceive a enrse ive as they ferral online. were i 29%* n the past and may no longer wei 6 ghting (meaning the b propensity 19% $199 annual sub for a 20% certain ty scription pe of to pers EBR on to I Notes be o and nline EBR ) r I Issue Brie educed the 36% fs. remain 73% Individual ing ga copies ps, but are av in ail o abl ther e 20% 30% 30% specialists or testing facilities 14% make chan Traditional plans include a broad ges 15% on their own; they range of pl lacked ti an typ me; an es, including health maintenance organi d they were already healthy. zations (H MOs), preferred provider organizations signific to partici antly patin leg in ss likely to say a we 49%* llness program, that they CD follHP enrol owed the lees ir tre were atment re more lik gime ely than ns for t tra heir diti co onal nditions plan enro carefllees to ully. But take people in a traditional HDHP health plan. 11% 22%* 18% 65%* Satisfaction and Attitudes 30% 20% 25% profile of the among CDHP CDHP and HDHP enrollees. respondents to the omnibus survey described below. Distributio Figure 23, Perce Health Reimbursem Checkn ed pri s f families’ ho rom an HSA ce of s ntage of In ervice be ent Arrangem m c e fore an be ma s, are dividual based de s Cov ents at on the highe any tim .............................................................................................. ered by Empl e. An st qualit individu oyment y, most depe al -Ba nee sed d not Health Ben be cover ndable informatio e efits With a Choice of Healt d by a high n. EBRI’s Web -deducti .................. ble hesite alth h po 40 sts access issues 50% due to costs. No significant access issues were found between CDHP enrollees and traditional plan The program is not conveniently located for you with prepayment for $25 each 29% (for printed 10% copie 18%s). Change of Address: EBRI, 1100 13th St. fit that Individuals label. 20% wit Prior research h HDHPs reported t has shown hat th tha ey had t cost sharin not openged an has be HSA en incre for a num asing across t ber of 28% reh asons: e board in the form of higher cases it did no 20% t reduce the remaining gaps. Perhaps the most striking difference in demographics between telephone 40% (PPOs), other mUnderstands you as a person, anaged care plans and plans with a broad variety of cost-sharing arrangements. The shared characteristic of this group is Subscriptions in CDH advantage o Ps witfh t de he h pression ealth risk weassessment and t re significantly more lik he health ely t promotion o say they pro follg owed the ram. Among those not ir treatment re 75% gime partns caref icipating, t ully hey getting care 35%* References .............................................................................................................................................................. 41 Plan, by Type of H all research finding ealth Plan, s, publi 22%* 2005–2009 cations, and n ........................................................................................ ews alerts. EBRI also extends its education and publi ........... c service 25 Respondents were asked a series of qu NW, Suite 878 estions regarding their , Washington, DC 14% attitudes toward th , 20005-40517 , (202) 659-0670; f eir health pla ax number, (202 n and satisfactio ) 775-6312; n with plan enrolle to w es ithdr during 20 aw mon 08, exc ey fro ept m the amon HSA g high (alte hough r-incom he e or indi she mus viduals,t h but H ave be DHP e en cov nrolle ere es wer d by ae hi foun gh-d d t ed ouctibl be more e he like althl y than plan at The 2009 surv including your work life, personal ey again examined opinions regardin13% g the appropriate use of lower cost sharin 73% g as an incentive to 20% deductibles an 15% d co-payments, and there has been a return to coinsurance. that the and o FINANCI nlin y either h A e sur L INCENTI 20% v ave no deductible or deducti eys was th 10% VES MATTER: e under 10% -re Financ prese bles that are belo ial inc ntation o entives f min w cur fo orities in rr healt ent threh sholds onli y beh ne that avior mattere sampl 10%would qualit es. d more y for a ta to C x-prefer DHP enrol red HSA 10% contribut lees than ion or There were 20% some statistically significant demographic differences among individuals enrolled in the three types of 24% 11%* To e A print ffici ed doc ently i ud ment entify res was a pon prdents eferrewho d choice wo You do not believe it will help you uld of qua informatio lify for n the C aboD ut h HP a 6%ealth nd HDHP ov pla 22% n benersamples, th efits for those 70%* e stu enrodlled in y used tradit Synov ional ate’s Endnotes than did not ....................................................................................................................... did those with tra 15% partici role to improving Ameri pate beca dus itional covera e they coul e-mc aan il: s’ finan d ma subscriptions@ebri.o ge. ke chan cial kn ges owle on rg dge their thro Me own; they lacked tim 10% mbe ugh its a rship Information: ward 28% -winning p e ........................................... ; and they Inquiries reg Major Reason ublic se were alr rvice arding EBRI cam eady paign 41 Chec 30% ked qual life, and beliefs ity rating of 20% 10% the tim reg •a rd Thirty-o t eo the funds va 25% rio ne per us as were pla cp ent ects of t reported that ced heiin t r hh eal e H tthey hS ca A). di re.d Distributio Qu not see t estio10%* ns w n hs are e ne ere asked ed excl 9% for th udeabout overall d e ac from count. taxable satisfacti incomeon if the with the health y are used to plan as pay for change th those withe tra way individu ditional covera als use the ge to re 22% he port a alth care ccess issues, e system. Res 22% specially ults co amo ntinued to sho ng those with w across-the-bo a health probl ard stron em and those g interest in with Figure 24, Main Re 25% ason for Deciding to Enroll in Current Health Plan, Among Individual 8% s With a Choice of 11% ® 11% 11% that are ge 10% nerall 10%y associated with HRAs. 8% traditional plan enrollees. Financial incentives were 8% a larger factor for CDHP enrollees than for traditional plan enrollees doctor/hospital 27% health plans. Individuals enrolled in membership and/or contributions to EBRI-ERF CDHPs were significantly more likely than should be directed to EBRI President/ASEC those in traditional plans to have a high ChoosetoSave and the companion site www.choosetosave.org omnibus surv plans a healthy. nd HD 10%e HPs, with Reasons for l y of mor slightly more e thaack of partic n 87,000 tha onlin ipatio n one e pa n -hal nel did not f mem prefdiffer errin bers who g by plan ty that o met ption (Fi the stu pe. gd ure y’s crit 5% 9). eria Whil(havin e one-h g private insur alf of CDHP en anrollees ce and Coaches you on staying healthy, You are worried that your employer will know your personal health 7% 4% 64% 9% 9% 18% Minor Reason 4%* well as satisfaction related to quality of care received, out-of-pocket expenses, and 22% choice of doctor. Roughly three- quali household inc fied me Health Plan or in the Non-Group Mark 10% 20% diome of $50,000 or cal expe 17% nses as defabove. ined under Internal et, by Type of Revenue Code Health Plan, (IRC) Sec. 2009 HDHP or CDHP Offered, 213( .................................................... d). Distributions for premi 3% um 3% s for 26 select networks composed of only medical providers with records8% of high-quality c 14% are 3% when combined with lower cost 10% 25% Chairman Dallas 12% Salisbury at the 16%above address, (202) 659-0670; $750–$999, 9% 6% e-mail: salisbury@ebri.org rather than just treating your health 64% when • This it came yearto partici ’s survey fin patin dsg in a re w duction elln information ess in programs, c the percentage hoice 15% of of doctor, indivi 15% duals and t wit he h traditional use of healt ch o i verage nform re ation tec porting t hnolo h 1% at th gy, as ey household inc Used onli ome: 3 ne cost trac 4 perce king tool nt of those in CDHPs had incomes of $100, 13% 000 or more c 9% ompared with 27 perca ent of those 10% 7% age preferre 21–6 d to 4.) re The ceive follo pri win nted informat g three question ion, 51 s were percent a usedl i so pre n thef J err une ed to and receive July Omni information via bus 12% Surveys to i e-md ae il an ntify l d 45 ikely C percD ent HP and 7 11% • Thirty percent c reported that they did not have the money to fu 11% nd the account. 13% 13% Traditional 8% 9%* 65% See Fronstin (20 CDHP 07) and problems http://ehbs.kff.org/pdf/2009/7936.pdf 61%* 17% 19%* quarters o COBRA (Cons f pla on enro lidatedllees, Omni w bus B hether udget enro Re lleconciliation d in a traditio 9% Acnal t of pl 19 an, 85 a C ), lon DHP, or an g-term care HDHP were insurance, h extremely or v ealth insurae nry s ce w atisfied hile sharing. One-fifth of individuals in CDHPs, 17 percent of individuals with HDHPs, and 14 percent of individuals with prov 0% ided by health plan Summary 0% 10% 5% 0% of Findings 11% 11% 11% 24%* 7% 11% Figure 25, Percentage of Individuals With Traditional Employment-Based Health Benefits Offered HDHP or well as patient 10% engagement using 10% e-mail and the Web. • EBRI is sup or a f Financ amily m 0% ial incee n ported b mber tives mattere delay ye o d d more ror avoide ganizations from all industries and sectors that appreciate the value of to C d D get HP enrol ting healt lees t h car han to e due to tradit the ional co22% st. Th plan enrol e resu lees. lts were Financial unc ince hange ntives d for were in traditional plans. CDHP an You already use a different program that you like better d HDHP enrollees were also more like 8% ly than traditional 14% plan enrollees to be highly 9%*ab c 4% 4% b HDHP res preferred to pondents: receive information through a Web site. CDHP and HDHP enrollees were more likely than traditional 4% plan 5% a 8%* bc 8% 3% In 2009, th Editorial Bo e sard: urvey fo Dallas L und a . Salisbur Not Offered a CDHP or Traditional $1,500–$1,999, 11% reductio y, publisher n in th ; Stephen Blakely e percentage , editor of in .HDHP Any divi views duals expr with tr essed in this p aditiona ublicat l covera ion and th CDHP ge rose o eporting t HDHP f the author hat th s sho ey or a uld ab 2%c with choice of doctor, and th Traditional e results have been consistent since HDHP 2005 (results not shown). CDHP 3% receiving une Printed mployment co Web Si mpensation, te E-mail and i nsuranc In P e e while rson el 35% igib Telephone le for Medicare other th Other 1% 1%an Do Not Get Any for Medigap, are Don't al Know so tax- traditional cov 0% erage were extremely interested in using select networks when combined with lower cost sharing (Figure 6% CDHP, 2009..................................................................................................................... Traditional HDHP CDHP ............................26 Uses medical terminology when 8This survey fin 0%ds that in 2009, 4 percent of the population was enrolled in a CDHP, up from 3 percent i 5% n 2008, and unbiased, reliable information on emplo indivi more a duals factor in HDHPs, with for CDHP enro HDHP, 34% on llees th e excean ption: for t There raditiona w yee b as a l plan decline enefits. enroll 3% in ees Vis the whe percenta it www.e n it came to ge o bri.ofr participati g HDHP e /about/join/ nrolle ng in for more. es with welln no ess health educat • not be Seventeen ed, ascribed to the officers, whi 5%ch may a percent r lsoe e ported xplai trust n th ees, that the tax e mdif emfbeers, or rences benefits were other sponsors of the E in behaviors not attractive and atti mploye tudes e Benefit Research enough. between theInstitute, the EBRI Educ groups. There weration and e few Fronstin (2009b). 0% 25% 31% 50% 75% 100% enrollees to 0% prefer to receive information through e-mail and a Web site. c Handbook or Information 3% family member delayed or avoided getting health care due to the cost. This decline was statistically significant for both explaining something to you Can send lab test results to Allows patients to set up Allows patients to request and Will answer patient's questions via Signing up for it takes a lot of work 16% 19% CDHP free. This means that distributions Total used to pay MedicaEmployment-Based re Part 32% A or B, Medicare Advantage Individual plan premiums, and the 17). CDHP enrollees were also more likely than traditional plan enrollees to be very interested in the conc 2% ept, with HEALTH STATUS IS BETTER, INCOME a HIGHER: Adults in CDHPs wer b e significantly less likely to ha c ve a health problem Resear ch Fund, or their staffs. Nothing herein is to be construed as an attempt to aid or hinder the adoption of any pending legislation, regulation, Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005–2007. Source: EBRI/MGA Consumer Engagement in Health Care 2 pSo ercent urce: EB in RI/M 2007; GA Consum and e er Eng nroagem Traditional llment ent in Health in HDH Care S Ps increase urvey, 2009. d from 11 HDHP percent in 2008 to 13 percent CDHP in 2009 (Figure 2). Figure 26, Perce probl programs, c eBooklet m who r h notage of In ie ce of doctor patients by e-mail ported adividual n ac aces nd t s s Wit is he sue. A us he of Employer C appointments online m health ong indivi informa ontributio duals tion tec with receive referrals online n to Acco a hnology, as we CDHP, the unt, Among Perso perce ll as ntage patient re e-mail n portin s engage With Employ g that ment usin they ment- g e- differences [ALL THREE QUESTIONS TO 0% 0% between 0% 0% Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005–2007; EBRI/MGA Consumer Engagement in Health Care CDHP, HDHP, an BE d tra ASKED OF ditional enrollTHOSE AGE 21-64] ees related to gender, age, and race. Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005–2007; EBRI/MGA Consumer Engagement in Health Care Survey, The 2006 survey fou 0% nd that 10%individ20% uals in CDHPs an 30% d H 40%DHPs w 50% ere less 60% likely to 70% be satisfied w 80% ith t 90% he quality 100% of care persons with a 0% nd without health problems, as well as for persons with less than $50,000 in household income (Figure a or interpretative Survey, 2008–2009. rule, or as legal, accounting, actuarial, or other such professional advice. 9 employee share of the premium for employment-based retiree health benefits are allowed on a tax-free basis. than 33 perc Trwere aditional = H ent o adu f CDHP e ealth plan w Survey, 2008–2009. lts in HD nrolle iHPs o th no deductible or esr traditio intereste <$1,000 (in nal d a pl nans. Adults in d d26 percent ividual), <$2,00 0 (fam of traditional CDHPs and H ily). plan enrolle DHPs were significan es interested tly less likely to smoke than . There was less interest See Figure 11 Fronstin (2009b Extremely Likely Allergies). Health Risk Assessment Very Likely Arthritis Somewhat Likely Depression Not Very Likely High Cholesterol Health Promotion Program Not at All Likely HypertensionDon't Know • Thirteen Source:2008–2009. EBR perc I/MGNothing A C ent reported th onsumer Enga Less than gemenat their t in Heal $100–$299 th C em are Sur plo vey, y $300–$499 er 200 wou 9. ld not $500–$999 have contr $1,000–$1,499 ibuted to $1,500–$1,999 the account. $2,000 or Don't Know The 4 percent of t Based Health a 0% he population with a Benefits and 0%CD CHP, 2009 D 10% HP represent 20% ........................................................................................... s 30% 5 millio 40% n adul50% ts ages 60% 21–64 with 70% pr80% ivate in90% surance, 100% whi .......... le the 27 s mail an kipped d t dos he es We to make b. Howeve the medicatio r, while CDHP n las tenrollees were more l long It costs too much er increased an $1,000–$1,499, 26% 6% d t ikely t 12% he ch hang an traditional e was statis plan tically s enrol ign lees ificto report ant, for the that Nothing Less than $500 $500–$999 $1,000–$1,499 $1,500–$1,999 18% $2,000 or More Don't Know b Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). a received thanSource: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005–2007 those in traditional plans. However, in 2007, the gap in s ; EBRI/MGA Consumer Engagement in Health Care atisfaction between those in traditional plans 40). For the a most part, the results were unchanged for individuals in HDHPs, with one exception: There was a decline HDHP = High-deductible health Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). plan with de $100 ductible $1,000+ (individual), $2,000+ (family), no account. More a Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. Less than 6 Months 6 Months to Less than 1–2 Years 3–4 Years 5 or More Years Don't Know in changi Tradi ng doctors to one tib onal = Health plan with no in de a se ductibllect e or <$1,00 netw 0 (ork combine individual), <$2,000 ( d w famiilth y). lower cost sharing. About 10 percent of individuals were were adults in traditio Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. nal plans, and were significantly more likely to exercise. People in CDHPs were also less likely to Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. b 3% 1. 13 c perc Which of the ent wit Survey, 2008–2009. Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. hSource: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. a H following be DHP represents 1 st describ 6.2 million es your current health insu people. Among the 16.2 mill rance status: ion individuals with an HDHP, 38 percent entire they wo grou b uld be ap, f inter or the ested in subgro ups w using se ith lect healt ne htworks of problems hi an gh–quality d for house doct holors whe ds with $ n com 50,0b 00 or ined more with low in income. er cost shari ng, Participation in Wellness Programs HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. 10 Figure 27, Annual Employer Cont CDH EBR bP I Issu = Consum e Brief z er-driven h is register ealth plan w ed in the U. ith deductible $1,00 S.ributions to Patent and T 1 Year r0+ (individual), $ adem the Account, Among Person ark Office. 2,000+ (fam ISSN: 0887 ily), w -13 ith account. 7X/90 0887 s With -137X/90 $ . CDHP, 2009 50+.50 .............................27 aHDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. and t Distributio hose n wit cs f a h CDHPs or non Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). quali disfie apdp me eare dical d beca expenses are use satisfaction subj i ect to ncreased sign regular income ta ificantly amon x as well g those wit as a 10h percent CDHPs an ped rem nalty, whic ained h in th The specific questions w e percent a aage o a a Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. f HD ere HP You feel employers should not offer this type of program as follo enrolle wses w : Does ith your no hea emplo lth yer prob offer a lem re ny of the portin follow 8%g an access issu ing wellness progr e. Amon ams? g individuals with a HDHP = High-ded Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). uctible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. • Eleven CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. perc Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). c ent reported that it was too much trouble to open and/o 11% r manage the account. 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). Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). be o extreme bese ly like com c lp y to chan Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). ared with ge, adults enrol and one-fift led i h n w a tra as very like ditional ly, health with pla no statist n. Adiults i cally signific n CDHPa s were nt diff sign erenc ific es antly more by plan ty lik pe (Figure ely than CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. b * Difference between H b a DHP/CDHP and Traditional is statistically significant at p = 0.05 or better. (or 6.2 million bCDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. ) reported that they were eligible for an HSA but did not have such an account. Thus, overall, Furthe when c it rmore, t came Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. to switchi he differen ng doctors if th ces in access issu eir doctor w es betwee as no n Ct in t DHP e he nrolle netw es and in ork, there divi was dual no di s in tra fferenc ditiona e by plan ty l plans, wh pe. ich b b b b 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). * 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. b th = 0.05 or better. unchan Employers an g CDHP = Consumer-driven h ed thr HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. d insur 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. ough HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. 20 ers of 09 (Fi ealt fehr a n g pla ure n with u 3 mb 4 de). ductible er of Th $1 edif previo ,00f0ere + (indiv nusly observed t typ idual),e $s of 2,000+ (family), with acc wellness benef gap in satisfaction ra ount.its—programs de tes for signed quality to promote health of care received is waive CDHP, th de ifper the ow c HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. entag ner o e increa f the HSA sed for dies, reporti becomes disable ng that they s dk , or ippe is eli d dos gib ele s t for M o make th edicare. e m edication last longer, and this * Difference between HDHP/CDHP and Traditional is statistically significant at the p a c 1100 13 Street NW · Suite 878 = 0.05 or better. Figure 28, Annual Employer Cont Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. ributions to the Account, Among Persons With CDHP, 2009 .............................29 * Difference between HDHP/CDHP and Traditional is statistically significant at p Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. c b = 0.05 or better. 18). Slightly c more than CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. one-third, regardless of plan type, was somewhat likely to change to a select network. those wit • Health risk assessment, where h tra c ditional CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. health coverage to you answer have a a questionnaire and the high household incom n a medical profe e. CDHP a ssional nd HDHP enrollees were also m examines your health history to ident ore ify I have health insurance ^ Difference from prior year shown is statistically significant at p c c c c CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. through a government p = 0.05 or better. lan such as * Differenc CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. e between HDHP/CDHP and Traditional is statistically significant at p < 0.05 or 0% better. 10% 20% 30% 40% 50% 60% 70% CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. a were Similarly, t not stati 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. ^CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. a Estimate is statistically different from the prior year shown at the p h CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. ers e was tically signi also su fic pport ant inin 2008, differi bng ecame so degreesin for =2 0.05 or better. 009. other ways patients could receive lower cost sharing, a Washington, DC 20005 ^ Difference from prior year shown is statistically significant at p CDHP = Consumer-driven health plan with deductible $1,000+ = 0.05 or better. (individual), $2,000+ (family), with account. and to prevent disease. * 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. c The 2009 EBRI/MGA Consumer Engagement in H = 0.05 or better. ealth Care Survey examined availability and remaine • Seven d bet perc w CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. een * Difference between <$50,000 and $50,000+ is statistically significant at the p ent tra report dition ed that al enroit was llees an either t d HDHP oo complicat enrollees. ed or th = 0.05 or better. ey did not understand the option. change was statistically signi # Difference between 2005 and 2009 is statistically significant at p * Difference between HDHP/CDHP and Traditional is statistically significant at p ficant for the entire group for th = 0.05 or better. e subgro = 0.05 or better. ups with health problems, and for households with * 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. * Difference between HDHP/CDHP and Traditional is statistically significant at the p Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. = 0.05 or better. any conditions * Difference between HDHP/CDHP and Traditional is statistically significant at p * Difference between HDHP/CDHP and Traditional is statistically significant at p # Difference between 2005 and 2009 is statistically significant at the p * Difference between HDHP/CDHP and Traditional is statistically significant at p © 2009, Emplo you may have or t yee B hate nefit you might Research Institute be at risk for developing. = - 0.05 or better. Educ =ation and Re = 0.05 or better. 0.05 or better. = 0.05 or better.search Fund. All rights reserved. likely than traditional plan enrollees to be highly educated. # Difference between 2005 and 2009 is statistically significant at p Medicare, Medicaid, or Veterans ben =efits 0.05 or better. (202) 6 ......................................... 59-0670 1 www.ebri.org www.choosetosave.org ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 ebri.org Issue Brief • December 2009 • No. 337 16 29 17 25 33 35 36 19 30 15 21 26 27 32 12 20 34 7 8 ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org A research rep ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri ort from the EBRI e e e e e e e e e e e e e e e e e e e e efffffffffffffffffffff • December • December • December • December • December • December • December • December • December • December • December • December • December • December • December • December • December • December • December • December • December Education and R 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 2009 • No. 337 esearch Fund © 2009 Employee Benefit Research Institute 38 42 37 10 13 11 31 18 39 22 41 28 24 40 14 9 6 5 3 4 2 Figure 21 Figure 6 Selected Demographics, by Type of Health Plan, 2005–2009 Trends in Cost-Conscious Decision Making, by Type of Health Plan, 2005–2009 a b c Traditional HDHP CDHP Figure 40 2005 2006 2007 2008 2009 2005 2006 2007 2008 2009 2005 2006 2007 2008 2009 Base: Adults 21–64 who received some health care in last 12 months Total sample 1,358 1,506 Access Issues, by Type of Health Plan, 2005–2009 1,918 1,714 1,651 487 930 1,404 1,634 1,603 186 722 895 972 1,184 a b c Traditional HDHP CDHP Gender a b c Traditional HDHP CDHP 2005 2006 2007 2008 2009 2005 2006 2007 2008 2008 2005 2006 2007 2008 2009 50% 48% 50% 51% 50% 48% 57%* 54%* 52% Male 49% 49% 53% 49% 57% 50% 2005 2006 2007 2008 2009 2005 2006 2007 2008 2009 2005 2006 2007 2008 2009 Total Sample 953 1,363 1,794 1,548 1,651 417 802 1,284 1,484 1,693 163 652 805 1,077 972 Female 51 51 50 52 50 47 51 49 50 52 43 50 43* 46 48 Total Sample 1,061 1,506 1,918 1,714 1,651 463 930 1,404 1,634 1,603 185 722 895 1,184 972 Married 60 74 78 67 78 61 55* 64* 62* 64* 59 61* 70* 71 70* Total Checked whether health plan would cover care 51% 58% 50%^ 55%^ 50%^ 61% 62% 61%* 61% 56%* 60%* 62% 60%* 63%* 61%* 47 42 44 37* 37 39* 45 46 49 Has children 34 42 33 35* 40 44 Not filled a prescription due to cost (you or family members) 16% 16% 17% 15% 15% 26%* 21%* 21%* 21%* 18%* 21% 23%* 19%^ 17 21* Asked for generic drug instead of brand name drug Skipped doses to make medication last longer (of those who were given a Age n/a 48 46 50^ 46^ n/a 60* 58* 58* 52*^ n/a 54 54* 58* 56* prescription) ( 21–34 you or family members) 27 33 34 15 33 16 28 16 18*15 24* 17 25* 21* 22* 20* 22* 25 22* 20* 22* 24* 20 23* 20* 17^23* 16 2823*^ Talked to doctor about treatment options and costs Not filled a prescription due to cost or skipped doses to make medication last longer 22 22 23 21 22 32 29* 29* 31* 28* 30 31* 24^ 23 31*^ 35–44 26 23 22 23 23 25 25 24 24 24 31 32* 31 30 28 Delayed or avoided getting health care due to cost (you or famil 42 y members) 44 44 17 45 19 33^ 16^ 56* 22^ 15^ 44^ 31* 49*^33* 49 32* 30* 37^ 28*58* 37* 4638* ^ 29* 47^ 2646 22* 40* 45–54 29 26 27 26 28 34 29 30 29 27 34 28 30 28 27 Any of the above 29 30 28 33^ 29^ 44 44* 43* 43* 41* 48 49* 38*^ 35 41* Asked doctor to recommend less costly 55–64 17 18 18 19 21 24 22 25* 26* 25 15 16 19 19 16* Health Problem** 27 31 30 36^ 34 46* 41* 43* 41 39* 45* 39* 38* 36 39* prescription drug Race/Ethnicity Not filled a prescription due to cost 21 18 21 19 19 30* 25* 24 25* 23 26 25* 26 23 26* Checked price of service before getting care 24 20 21 23^ 25 35* 23^ 27*^ 23^ 29^ 29 26* 27* 25 35*^ White, non-Hispanic 71 71 71 72 70 94* 83* 78* 77 72 93* 81 75 76 72 Skipped doses to make medication last longer (of those who were given a Checked quality rating of doctor/hospital 18 21 20 25^ 24 22 18 19 22 22 18 19 18 23^ 27* Minority 28 29 29 28 30 6* 17* 22* 24 27 7* 19 25 24 28 prescription) 21 21 23 21 21 32* 28* 28 30* 30* 30 29* 24 22 32*^ Used online cost tracking tool offered by health Household Income Not filled a prescription due to cost or skipped doses to make medication last longer 29 27 29 28 29 40 35* 35 38* 36* 39 38* 34 32 40* plan n/a 8 8 12^ 12 n/a 6 9^ 10 9* n/a 17* 20*^ 20* 24* Less than $30,000 15 12 15 14 11 11 17* 12* 9* 10 11 13 6* 4* 3* Delayed or avoided getting health care due to cost 20 23 18^ 23^ 17^ 31* 37* 35 34* 34* 44* 42* 32^ 32 29* Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005–2007; EBRI/MGA Consumer Engagement in Health Care Survey, 2008–2009. $30,000–$49,999 19 20 18 19 17 19 30* 18 14* 16 22 24 13 10* 10* Any of the above 35 34 33 37 35 48 50* 49 49* 49* 58 55* 46^ 44 49* a Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). $50,000–$99,999 34 38 36 36 38 36 35 38 40 43* 33 43 41 40 45* No Health Problem** b HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. $100,000–$149,999 14 14 14 14 17 11 5* 14 19* 16 13 7*^ 20* 25* 24* Not filled a prescription due to cost 11 13 12 9^ 9 48 17 17 16* 11^ 15 22* 13^ 12 15* c CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. $150,000 or more 7779 10 4 3* 9 9* 8 9* 4*^ 11* 15* 10 Skipped doses to make medication last longer (of those who were given a * Difference between HDHP/CDHP and Traditional is statistically significant at p Education = 0.05 or better. prescription) 8 11 8^ 7 12^ 15 15 13 12* 12 10 17 11^ 10 14 ^ Difference from prior year shown is statistically significant at p Not filled a prescription due to cost or skipped doses to make medication last lon High school graduate or less = 32 0.05 or better. 38 42 ger 14 33 18 35 16 14*13^ 17* 14 14* 22 2213* 21 14* 21* 6*15 11* 20 25* 11* 16^10* 16 8* 24* Delayed or avoided getting health care due to cost 13 16 14 21^ 12^ 31* 28* 27 26 20* 31* 35* 26^ 22 15 # Difference between 2005 and 2009 is statistically significant at the p Some college, trade or business school 31 = 0.05 or better. 29 29 31 31 36 36* 30 28 26 28 33* 24 22* 24* Any of the above 20 25 23 29^ 21^ 39 38* 37 35 31* 39 44* 32^ 29 32* College graduate or some graduate work 24 22 20 24 23 34 35* 40* 42* 42* 46* 41* 41* 44* 46* Less Than $50,000 Yearly Household Income Graduate degree 13 11 9 12 11 16 12 17* 17* 18* 20* 15 24* 24* 21* Not filled a prescription due to cost Self-Rated Health Status 24 20 27^ 20^ 20 28 25 27 26 23 24 23 27 19^ 25 Figure 7 Skipped doses to make medication last longer (of those who were given a Excellent/very good 42 54 49 56 59 50 53 54* 54 59 58* 60* 65* 66* 64 prescription) 21 21 25 21 25 31 23 28 27 29 30 26 23 20 29 Good Availability a 45 nd Us 35 e of Qua 38 lity a 34 nd Cos 32 t Informa 36 34 tion Pr35 ovided by H 34 ealth P 30 lan 34 33 29* 30 27 Not filled a prescription due to cost or skipped doses to make medication last longer 31 29 33 28 29 38 31 36 35 33 36 33 32 28 35 Fair/poor 13 12 13 10 9 53 13 10 12 11 9 7* 6* 5* 8 and Effort to Find Information From Other Sources, 2009 Delayed or avoided getting health care due to cost 24 29 26 35^ 18^ 41 36 40 37 39* 49* 40 34 33 38* At least one chronic health condition** 54 49 49 52 52 56 50 53* 56 54 48 43* 45 45* 46* Any of the above 39 42 41 47^ 36^ 53 48 53 51 50* 56 53 48 45 50* a b c Health problem*** 57 51 53 54 54 57 Tradit53 ional 55 HDHP 57 57 49 CDHP 44* 46* 45* 49* $50,000 or More Yearly Household Income Obese Health plan provides inform 36 ation on qualit 30 y of 27 care provided by 26 31 33 28 30 29 28 26* 30 25 23 23* Not filled a prescription due to cost 12 13 12 12 13 24* 19* 19 19* 17* 19 23* 16^ 16 20* Smokes cigarettes 23 24 24 20 18 14* 18* 14* 15* 13* 14* 14* 15* 13* 13* doctors 42% 29%* 41% Skipped doses to make medication last longer (of those who were given a No regular exercise 24 25 25 25 21 15* 25 20* 21 19 16* 19* 17* 17* 13* prescription) 13 14 13 12 15^ 23* 20* 19 21* 21* 16 21* 16^ 15 22*^ Firm Size (base: employed full- or part-time) Health plan provides information on cost of care provided by doctors 36 25* 35 Not filled a prescription due to cost or skipped doses to make medication last longer 18 19 18 17 21^ 30 27* 27 28* 27* 28 29* 22^ 22 31*^ Self-employed with no employees 24323 9* 9* 9* 7* 7* 8* 5 6* 7* 5 Delayed or avoided getting health care due to cost Of those whose plans provide info on quality, how m 13 any tried t 14 o use 12^ 16^ 14 28* 30* 29 28* 25* 31* 37* 29^ 25* 20* 2–49 15 19 19 16 15 31* 32* 27* 26* 25* 39* 32* 28* 25* 21* Any of the above 24 25 23 26^ 27 40 41* 40 40* 38* 45 47* 36^ 33 40* it for doctors 45 47 61* 50–199 8 10 11 12 11 9 14 14 13 15* 8 12 11 13 12 Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005–2007; EBRI/MGA Consumer Engagement in Health Care Survey, 2008–2009. Of those whose plans provide info on cost, how many tried to use it a Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (famil 200–499 9898 y). 10 6877 7* 5* 10 87 7* for doctors 41 36 54* b HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. 500 or more 54 45 43 50 48 33* 29* 36 38* 37* 36* 31* 40 42 48 c Tried to find information from sources other than health plan on cost CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005–2007; EBRI/MGA Consumer Engagement in Health Care Survey, 2008–2009. and quality of care provided by doctors 17 24* 28* * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. a Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). ** Health problem defined as fair or poor health or one of eight chronic health conditions. Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2009. b HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. a ^ Difference from prior year shown is statistically significant at p = 0.05 or better. Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). c CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. # Difference between 2005 and 2009 is statistically significant at the p b = 0.05 or better. 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. c CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. ** Arthritis; asthma, emphysema or lung disease; cancer; depression; diabetes; heart attack or other heart disease; high cholesterol; or hypertension, high blood pressure or stroke. * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. *** Health problem defined as fair or poor health or one of eight chronic health conditions.

Volume 337

Pages 44

EBRI Issue Brief

Paul Fronstin

Health