The ranks of people enrolled in either a consumer-driven health plan (CDHP) or a high-deductible health plan (HDHP) reached 22 million in 2010, according to a new report by EBRI. Participation in these account-based health care plans is low, but continues to grow, EBRI finds in its sixth annual Consumer Engagement in Health Care Survey.

SIXTH ANNUAL SURVEY: This Issue Brief presents findings from the 2010 EBRI/MGA Consumer Engagement in Health Care Survey. This study is based on an online survey of 4,508 privately insured adults ages 21–64 to provide 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.

ENROLLMENT LOW BUT GROWING: The survey finds continued slow growth in consumer-driven health plans: In 2010, 5 percent of the population was enrolled in a CDHP, up from 4 percent in 2009. Enrollment in HDHPs increased from 13 percent in 2009 to 14 percent in 2010. The 5 percent of the population with a CDHP represents 5.7 million adults ages 21–64 with private insurance, while the 14 percent with a HDHP represents 17.2 million people. Among the 17.2 million individuals with an HDHP, 37 percent (or 6.3 million) reported that they were eligible for an HSA but did not have such an account. Overall, 12.1 million adults ages 21–64 with private insurance, representing 9.5 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, such as having checked whether their plan would cover care; asked for a generic drug instead of a brand name; talked to their doctor about prescription drug options and costs; talked to their doctor about other treatment options and costs; asked their doctor to recommend a less costly prescription drug; developed a budget to manage health care expenses; and checked prices before getting care.

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, and equally likely to report that they had access to a health promotion program. HDHP enrollees were less likely to report having access to a health promotion program. CDHP enrollees were more likely than traditional plan enrollees to take advantage of the health risk assessment and the health promotion program.

FINANCIAL INCENTIVES NOT A FACTOR, BUT HIT IS: Financial incentives were no more a factor for CDHP enrollees than for traditional plan enrollees when it came to participating in wellness programs. However, CDHP and HDHP enrollees were more likely than traditional plan enrollees to choose a doctor based on his or her use of health information technology (HIT).

HEALTH STATUS IS BETTER: Adults in CDHPs were significantly less likely to smoke than were adults in traditional plans, and were less likely to be obese.

INCOME NO LONGER HIGHER; EDUCATION DIFFERENCES REMAIN: While in the past, adults in CDHPs were significantly more likely than those with traditional health coverage to have a high household income, most of the income differences were not present in 2010. However, CDHP and HDHP enrollees were more likely than traditional plan enrollees to be highly educated

Figure 38 Figure 12.1 Trends could m e-mail, the 3 [ALL 16 Figures Indivi CDHP enrollees were more li $1, ?00 perc millio 8 Whil THR duals ar 0 (F an 23, perc ent o ake c e i id Mai gu n a E ent n w E r fh th e able to e d as able HDHP enrollees were satisfied an QUE n anges o who 27 ults a Reason e past, adults i ). In f w S g to TI es e roll nre o for th a ON use 21– ct, o eir fS TO Deciding to En fv 64 6 real-tim kely than e own er fu 2 red nwith p e CDHPs w eith rce (Fi nds B privat E e, virt n AS g er a t of fro ure tradi m KED in 1 e ual visits for e insura CDHP or roll in one HSA i re t1 ional d): signif ivid OF T 32 d Curr u plan 22 perc percent n al HDH icantly mo ce, s H ent n w enr OS “f to another riFigure 26 th e Figure 11 Figure 11 P, 1 ace-to-face ent Heal prese E AGE 21 o f ci llees to a6 ted this mil of th re percent n CDH y like tPlan, cover ing 9. HSA take l” as a P y tha - Among I cparticipants witho 64] were offered a 5 percent o age nsultations (Figure 16 advantage o major reason n t get h uose wit t su a co ndivi of bjecting t we t du nt h fh CDHP at market, ribution re satisfie tra a healt als and Wit ditional h ,31 percen 12 per e distri h h a of at l ). Ge risk d w Cho (Fi health enerally, about a bution re cent e g ssessment and ice of ast $1, ure t cited it either c 3 were offered a o to i Healt 5 verage ). 000, in Bet n as a a co h CDHP one- with me an w to een d Figure 32 Appendix—Methodology Figure 24 Figure 21 Figure 28 Figure 17 Figure 36 Figure 13 Figure 34 Figure 30 Figure 15 Figure 3 Figure 5 Figure 1 Following Treatment Regimens for Five Most Chronic Diseases, 2010 Figur Figure 9 e 19 Reasons f Reasons fo or r Not Not P Pa ar rt ti ic ci ip pati ating ng i in n Empl Emplo oy yer ers s W We el ll ln n aess ess Pr Progr ogram am Among Among Those Those Annual Employer Contributions to the Account, References Introduction a ? Programs for impro Per vcenta ing yo P ge of e ur rcentag health, Individuals Amount e like fo of Indi r weight lo Rolled Over fr Co vidual vered b s Wi ss, y th Emplo wa Tradi lking o om ty io ment-Based P nal ast r otEmplo her exercise, Year, 2010 y Health ment-Based nutrition, Benefits stress mana With gement, 200 minor reason partici HDHP, 29 Paul or wer half or penalty perc 9 a Fronstin have p e more n an tax ate ent i d Plan n 20 d 10 a hi e in get n s o 1 i gh for not health 0 as long as the HDHP that s ftperc or in the No CDH , satisfaction director ing household incom $1, ent wer promoti P an partici 000 of d H wa (P –$ t e offer p n-Group h ercentage of rollover D s eligibl o with t 1,49 ating. e Hea n pro HP e 9, 9 e, most of ed an h nrolle lg Lack o th e e rams. does Market, by p for oRes ut-o erce H es are pr a D e iv f n not exc However, fHP arch a time nt g -pock the HSA ately insured adults 21–64 with an likely etting Ty income d di was th e but n e t cos pe o d Edu e to d had not o d no fina $ 60 1 ftc di e Health s,h cation Pro ncial i 500 t know if they drop days. Rollover contributions seco oose a ffer –$ ences ped nd most np 1,99 Plan, 2010 cent en docto amon g ed t 9, a ra ive were m at th r based on his h s popular nd were offered a mattered e e acco g no chronic conditions who peop 24 .............................................................. t prese e Empl pe unt. reason le i rcent n When t n q oyee B ea t i or her use of ually to from Arc gettin n ch type n for not 2 account. 0h e 10. Ho eir g ne CDHP at partic of chil fit h leas er he R wever, dren ar e MSAs are a HIT, whereas and tra a isearch I p t $2, lth p atin CDHP a 00 g, with lan. e cou d0. itio n stitute lso nal nte n 24 per- d pla d, n . 24 Interest in P Likelihood of Changing Doctor If Cost Sharing was Lo Premium Increases P eP r ecenta e rcenta rcenta Length of Fg a Number of g e Enr Ann miliarity g of Individuals e Extremel e Extremel o u lling al Time Individual Contrib With Consumer in Y Among Emplo ear y With CDHP Plan Using Select Netw y or s or Repor V Co V er evered y r Likel y Satisfied ting -Driven and Sa y b u y to Recommend er The y tions Current s With 10 y vings Account, With Overall Health W Health Plans, to ould the Account, orks Health Plan, or More Emplo PrComposed obab Health wer or Higher 2010 ly P 2010 ar Plan to t Plan, of Onl icipate yees, y There has been no clear AEmplo g incr reement ease in yer Off the Wit eh sh rs S W are of tat ellness ement CDHP Pr s e A ogram, nbout rollees P b who ry oposed Ty rpe of Health eport cost-con Ways toPlan, E scious decisio ngage 2010 n-making over the The findings presented in this Issue Brief were derived from the 2010 EBRI/MGA Consumer Engagement in Health Care a Off Offered b ered b Among P u ut t Not Not eP P rs ar ar ons t ticipating in icipating in With CDHP b Pr Pr ,ogram, ogram, 2010 c 2010 2010 1. Which of the following best describe Choice and No Choice of Health Benefi s your current health insur ts Health Plan, Offered HDHP by T or ype CDHP anc of Health e statu , 2010 s:Plan, 2010 strongly/some strongly/somewhat what ag agree ree tthat hat the they y ffollo ollow w ttheir heir ttreatment reatment regimens regimens v ve er ary y carefully) carefully) (EBRI Figure ). This 1, Premium Incr Issue Briefeases Among Employers was written with assistance from With 10 or Mor the Instit e Em ute’s research ployees, Work an er Earni d editorial ngs a staffs nd In . Any views flation, smoking cessation, and so on. cent r about permitte enrolle between HDHP enrollees were more li e21 es. portin d. Ear 4 milli 0 -g it as a 5 on in nings o 0 percent dividuals When Using Doctor major n in contr of Medical Emplo tr b with reason an iy aditional butions Household yprivate er Pr kely than o W W are plans v d e orker Earnings and Inflation, ider llness Pr in 27 perc al s surance, r so not subject s enroll Who Use Health Inf tradi b Income With Recor y T ent t yional pe of Health Plan, ogram, ees ar arepo e , Among P pre plan e rting s to incom b d enting abo likely to enr s y it as a of Pr Vo allees to e rious Cost Sharing ormation rdo so. e ta s o mi ons v uiding t 2010 x nor reason. be 12 1988–2009 e s. With hi perc High-Quality T ghly eCDHP ent o chnology (HIT) and edu Fo f rty-three perc ,the market, cated Incentives 2010 . Care There wer went ere e did not either few dif inf a er CDHP ences Employment-based h Chernew, Michael E., Alli ealthson B. Rosen benefits are the most common form Friend or Co-W , and A. by Ty orker pe of Health Plan, Mark Fendrick. “Valu , by Type of Health of heal 2005 th insura e-Based Insur – Plan, 2010 n 2005 ce in– a the 2010 nce Design.” United States. In Health Aff 2009 air , 15 s. 6.1 40% five years of the survey Consumer (Fig (Among P ure 7). s ein M Howe rsons aWit naging H ver, amon h CDHPg tra ealt Who h d C itional Haa vr ee Had plan CoAccount More st es, nrollees, by Type of a sta Than One t P istically sign lan,Y 2010 ear) ificant increase in the Survey, an Definition onls ine survey that examines issues surrounding consumer-directed health care, including the cost of 50% Figure 24, Percentage of Individuals With Traditional Employment-Based Health Benefits Offered HDHP or CDHP, Indivi As in expr Overall, amon essed i duals previous n wit tg years of his report are h HDHPs r persons el the epo igi sth u b rted t rvey, in le ose of to contri hat th the diviey a bu du ute to a had als in C thor an not o nD d sho acco HPs a penu uld ed an n nt, d H not 13 HSA D be HPs w perce ascribe for a nt er di e num fou d not d to t n ber o d to contri he officers, trustees, or other fbe rebute asons: less likely t anything, han with those i 20 n spo perc tran d esors int of tional 100% 1988–2009 ..................................................................................................................... 60% Current Combined Doctor Does Not Use HIT With Lo and T wer ype of Health Cost Sharing, , by Plan, Ty b pe of Health Plan, y 2010 Type of Plan, 2010 2010 .......................... 6 40% million or an HSA partici Web Exclusiv by plan ty p 70% individuals un ate 50% 70% -el because th igible pe a pla e, (Jan s they relate der n. ey were alr age 6 . 10, 2 5, or t 007): w195-w203. e oady ge 59nder, pe hea rcent o lthy (20 percent report age, and f that race. population, Les s than ed it $200 had employm as a major rea ent-based hea son and 23 lth percent r benefits e(Fro ported it as a nstin, 20% percentage reporting cost-conscious decis aion-making between 2007 and 2008 was followed by a statistically significant insurance,80% the cost of care, satisfaction with heab lth care, c satisfaction with health care plans, reasons for choosing a 9 I have heal 18.6% th insurance through a government plan such as 45% Decem of EBRI, ber 20 EBRI 1 25% 0 • -ERF, or No. 35 their 2 staffs. Neith 55%^ er EBRI nor aDon't know EBRI-ERF c lobbies or takes positions on specific policy proposals. 2010 .......................................................................................................................... 80% Traditional HDHP CDHP b 4% 65%*............................. 25 For analytic purposes, reports of chronic health conditio 35% ns and fair or poor health were combined into an indicator of health plans those wit The It is not 20 both to 10 clear h ho surv usehold recommend th from the ey examine incom data d o e b wheth eir h You You pinions ec clow an mak an mak ealth er th $ regarding e c e c 50,0 pla e hanges hanges di n00 a to a ffer on y on y t e nd nces h our our friend or 1 e appro own own 2 in co percp en co-worker nsumer e riate t of use o those 32% 32% n an ga f lwith d to stay o gement c wer cost sh househol with t an a be d in ring as an h attribute eir c come o 31% 31% 37%* urrent ince d f at to h least plan n etive to alth $50, design plan chan 00 if th 0ge the ey Health Rei 45%mbursement Arrangements 89% 40% 45% 53% minor reason). For the most part, there were no Traditional differences HDHP CDHP in the answers to this series of questions by plan type. 2010). In every year since 1998, premium increases 9% 63% hav * e exceeded worker ear Offered CDHP nings increases and inflation (Figure 1): 35% b Health Savi decrease ? One-th in 90% co ird re ngs Accounts st-conscious behavior i aported that th 52% 62%*ey did not n so have me of 62% the the a * money to answers. Other than with r fun c d the account. espect to checking whether the health plan, and sources of health information. It also presents findings from the 2005, 2006 35% , and 200 86% 7 EB 86% RI/Commonwealth Medicare, Medicaid, or Vet a erans Premium Increase bc benefits ................................................ 1 Worker Earnings Increases $200–$499 73% Overall Inflation EBRI invit Figure 2, Distribution 45% es comment on of 61%Individuals * this research. Cov ered Traditional by Privat HDHP e He CDHP alth Insurance, by Type of Health Plan, 2005–2010 ............. 6 18% Traditional 10% 17.1% 18% 66% 43% 72% 72% 16% c Traditional HDHP CDHP b ab problems. People were defined as ha had t HRA and HSA way in differences or contributi ? A he o divi mong n ppor n dual g in o t s use the h enrollme wheth d unity to s thing (Fi ividu 16.7% e ar vario ls w n gt is w ure e iitc th algrowi 28 th care syst u h e s pla pl m ). ans plo n The n g, ving a y design (Fi m mos but eg n em. Results show across- ur t t -health problem if they aes 36 h t b s attract a c signi e market ased an h ficant ed a pen l37 th di e ). b rffe t Similar e e ain kin ctration r ne refnce its, said they were in d to th t in o the- h e co o fmai i sn b e e ntributio d i o satisfaction nividual. R n C ard s relative strong DH71% P n fair or poor h s w s by e ly s ga interest i equestions, the re household inc rdless, it m m all an oren d t le sel ik is clear that t alth h ele a e y or h ct net t ome can perce m han ount of a th d on w n 1orks co tage o be se s h e of ei e time e w of ith mposed en i CDHP gh t n Claxton, Gary 35% , et al. “Health Benefits in 2008: Premium Moderately Higher, Whil82% e Enrollment in Consumer- 49% 49%^ 40%* 2005 40%* 2006 2007 2008 Tra 9% dit2009 ional 2010 HDHP CDHP Where the world turns for the facts 70% 67% a on U.S. employee benefits. However, C Health insuran DHce P enro premiums have llees You You we do not hav do not hav re more more T e enough e enough raditional likely 48%^ tha time time n than tra do to par to par c HDHP ubl tic ticiie pate pate d, wh dition CDHP a ile worker ear l plan 24% 24% enrollees not to nings have inc 81% 81% parti 27% 27% reased 43 cipate becaus pere they cent. were worried A health reimbursement a 50% 69% rrangement 66%^b(HRA) is an emplo 2005 yer-fu 2006 nded 2007 health plan 2008 58% 2009 that reimburses 2010 employees for qualified Figure 60% 25,60% Percentage of Individuals With Employer Contribution to Account, Among 39% 80% Persons With Employment- plan wouI have heal ld cover care, th insurance there were no stat through my job istically sign or the job ificant d ecreases between 2009 and 2010 among individuals with Fund Consum 40% 40% erism in Health Care Survey, and the 2008 and 2009 EBRI/MGA Consumer Engagement in Health Care 70% Traditional 64%^ HDHP CDHP A health savings account (HSA) is a tax-exempt tr 38%* ust or custodial account that an individual ca 21%n use to pay for health Don't K 63% now if CDHP or ? Thirty-o 35% 80% ne percent reported that they did not see t 66% he need for the account. 66% chronic health conditions (arthritis, asthma, emphysema or lung disease, cancer, depression, diabetes, heart attack or 45%* other of only enrolle under indivi the lik Directed Plan traditional dlying ch elihoo uals es re medica 40% ha po d aracteristics of the po ve been of contri rting t l provi cov s Ri ehat th rage to d in ers se buti the s In Small Firms. wit ng at l eyshave woul h e pla recor east $ a choice of health n d s is lo pulatio d be s of extr 2,00 hi wn ” e emely or 0 s enroll gh-qual r tha Health Affair to th ne a time ed in ity car very plan. ccou e thes n s. e likely to nTwo rolle w t. About Web Exclusiv e hen -thir plans ar d in combi recom tra ds 37of indiv d e different: percent in tm ional cover ed wit e (Sept. 24, 2 end iduals with their of h lo Adults in individuals we p age. Among in lr cost sharin an 008):w492 to a an employment CDHPs fri with en ho g di d.were sign o - viduals Thirt usehold incom r co-worker w502. -based een with perc ifica CD nent of tly HP e of 16% 16% 61% 54% 74% that their em ployer would know their Totaperso l <$50,000 Inc nal health ome info $50,000+ Inc rmation, an ome d they were more likely not to participate because Figure 3, Number of Years C HDHP overed by C Was Offered 60%^ urrent Health Plan, by Type of Health Pla 14.7% n, 2010 .......................................... 8 medical ex 30% peof another family member (suc nses. HRAs are typically combined wit h as spou h a hi se or gh-de pd arent) uctible ............................. health plan, though this is 2 not required. HRAs traditional Based H coverage. ealth In Benefits and C contrast, there wa DHP, 2010........................................................................................... s a statistically significant across-the-board drop between 2009 and 20 ........... 10 in25 Survey. The 2010 EBRI You You do not need do not need /MGA Consumer it bec it becaus ause y e you ou Engagement ar are alr e already eady healthy healthy in Health 20% 20% Care Survey was 23% 23% conducted within the United States 52% care expenses 60% . Contributions to the account are deductible from taxa 28% ble income, even for individuals who do not 20% 29% heart disease, 30% high cholesterol or hypertension, high blood pressure, or stroke). 69% indivi increased fro traditional less likely to at least reporte duals $5 cov 0,0 in h d m CDHPs, 1 th 00 co ave a e 30 percent rage, at the em ntrib healt 20 0u perc per ted hployer to 39 percen problem t cent of $2, ent ha 00 contribut 0 or d in h been divi an more to t t w duals wit betw eie d nre a to their een the dhults 2 e ac h plan account. HDH 006 in H co fo and unt, w Pr th D s, and 9 HPs or tra 2 ree to Among 0h 0ere 7, an pe a four s pe rc d d rea 24 iti ent of rson years an operc nal cs eligibl he in plans. A ent o d divi 45 d du 43 fe perce to co those wit d als with percent for ults in nt in ntribut CDHPs traditi 2 h ho 00 e five or mor 9 to usehold . 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As mentioned above, 38%*^ despite this drop, between 50% Augu 40% st 9 and August 24, 2010, through a 17-minute Internet survey. TThe raditional nationa HDHP l or ba 52%* CDHP se sample was drawn itemize their taxes, an You You d ta jus justtx-free distri do not k do not know enough now enough butio about about ns for the pr the progr ogr qual am amifi 32%* ed medical expenses are not counted in tax 32%*able 37%*^ income. Tax- Fronstin, Paul. Consumer-Driven Health Benefits: A Co 8% 8% ntinuing Ev 23% 23% olution? Washington, DC: Employee Benefit Figure 4, Length of Time With $2,000 or HRA or mor HSA, e 2006–2010 ........................................................................................... 8 Figure their att extreme 37 signific less than This com perc 13 antly 26, ent e ly int perc p ntion $5 Annual Em ares in 0, le ent e201 000 ss likely to sm to accou r with ested di 0. On contri d not contr 2in 8 ployer e-hal perc n usin bute t-ba e Contributions g sel foke than d $ sed h n (48 ibut t an 12.1% 2e percent ,0 e ct n d e anythi 00 alth 16 w or m etwo pla perc ere ) ng. to r adu n of traditional o ks when ent, res s—a combin re to th the Account, Among Pers lts inp com e ac trad ectiv plan ca b io t e tine ional unt. ion ly, amon d eof hea n wi plans, a rolle th lower cost shari g es lth pe ons Wit were n rsons in a plans d th extr ey with h C were emel CD D deductibl HP, 2010 n30%* g HP (Fi signific y or very (Figur 49%* ge antly m ure e 17). ..................................... s of likely 3at l ). While CDHP enrollees were o to recomm e re like ast $1, still ly to 000 low en for e d th r tha eir 27 n economic security. Founded in 1978, EBRI is 53% the most authoritative and objective source of 53% used without permission but citation of t 27% he source is required. insurance company .............................................................................. 3 50% 29% Employees ar 10 25% e eligible for an HRA only when their employer offers such a health pla 34%* n. 47%*^ CDHP enrolle 30%es were more likely than 18% those in traditional plans to exhibit a number of cost-conscious behaviors. from Synovate’s online panel of Internet users who have agreed to part 11.2% icipate in research surveys. About 2,000 adults 30% 60% 60% According to C 12% laxton et al. (2 57% 57% 008), 28 percent of employers 56% 56% 25% offering coverage through HSA-qualified HDHPs do not make free distri ? Research In Fourteen butio 30% 25% You You n perc s are stitute, 2002 ar are unc e unc ent reported t also all omfor omforttable able owed for par par . tic tich iipating pating at it certa in this in this was too k kin premiums. iind of pr nd of pr much trou ogr ogram am ble to open and/or mana 42% ge the account. 32%* 28%* 24% 55% Figures also more l plan, the exercise. perce compare 12 Peo ntage of ian kel p d 1 d w y le in than tr 3 in i co th CDH dividual ntain 27aditio perc Ps w fis with ndin e nal ent of re also plan gs from traditio HDHP less li enrol a e nal covera lkely to series of e nes to rollees. be be o qu ge, somewhat The estions relat b e the perce s 9% 9% e compare number of persons n inter tage e 18% 18% d to the of ested d with indivi in t adults impact dh uals e co with en ext th nc CDHPs rolled in 24% ept, remely or at fin with ancial and the length a tra 40 very inc percent ditional likely entives cou of C to stay health of time they DlH d plan. P have with employee information on these critical, complex issues. -only 50% coverage and tax-preferred savings or spending accounts that workers and their families can use to pay I have other health insurance (specify _______________) ............................ 4 42%*^ Findings From the 2010 EBRI/M 25% GA Consumer Engagement in 40% with y with y our 10 10 c .our 1% 1% owor cowor kerskersw 10.1% 10.1% 30%* 24% 24% 52% 15%23% 23% 41%* 25% 26% Figure 5, Familiarity With 51% Consumer-Driven Health Plans, 2010 40%*^ ................................................................................. 9 40%* (n=1,996) ages 21 b -64 who 23% 23% have health insurance through an employer or purchased directly from a carrier were Figure contributions t 40% 27,40% Annual Em oward the HSAs that their wo ployer Contributionsrkers establish. This accounts for 26 perc to the Account, Among Pers 50% 38% ons With Cent of covered workers enrolled in HSA- DHP, 2010 ..................................... 27 Indivi ? In 2 dual0 con 06, th tributions e survey fo to tund t he acco hat in unt a divi lso vary by duals in CDHPs a whether a nd HDHPs n 28%* individual has were less likely to single coverage or be satisfie fa d mily covera with the quality o ge. f Recommended C 15% 30% itation 37% : Paul Fronstin, “Findings from the 2010 EBRI/MGA Consu Offered HDHP mer Engagement in Health Care 10% 40% 25%HDHP 10% 22%* 37%* 27%* 27%*^ 66% 37%* on part have bee their o enrolle their CDHP a health u es int icipat n t-of-po I do not hav d HD n 50% e pl er n ion in rHP enrol an if ested a o cket hea lled w th in eey coul n e lln these l health d 3 ees lth ca ess programs. Eve 3were plans have be perce d switc re expenses. E in also mor sura nt of h was nce cu trae d unchan n en like itional m amon rrently ployers first in ly tha creasin plan gg e ...................................................... d pers n a tr g e m (Fi aditional n ons not ong those rollees stg arted offeri ure plan 4 inter partici ). w e i th tra enrolle sp n ted. T atin g accou d g in itional es to here th nt-based w eir be hi coverage as about employ ghly health 5 educa but the er’s plan same amou w dropped from te ed. llness s in 2001, progra nt o wh 200 m, f en a 9 Employers hav 25% e a tremendous amount of flexibility in designing health plans that incorporate an HRA. For example, the 25% 36%* ? Thirteen percent reported th 20% T The pr he progr ogram am 23%* is is not not at their c conv onveniently eniently em 23% loc locplo ated ated yfor for er y y wou ou ou ld not 14% 14% have contr 19% 19% ibuted to the account. 19% 35%* 35%*^ 12% Availability 20% and Use of Cost and Quality Infor 25%* mation HSAs are owned by the individual with the high-deductible health plan and are comp $500–$749 letely portable. There is no use-it- drawn ________. “Health S randomly from t 13% avings Accounts an he Synovate sampld Ot e for t her Account-Based Health Plan his base sample. This sample was str s.” EBRI Issu atified by e Brief, gender, a no. 273 13% ge, region, Survey,” EBRI 20% Issue Brief, no. 351, December 20 33% 33%* 10. 8.1% qualified HDHPs. Health Care Survey 8.0% Specicare rec fically, 40% in edividuals w ived than those in ith single traditiona coverage are l plan more s, but lik duri elng y than those with fam 2007–2010 t 21% his gap ily co in satisf verage to cont action disap ribute less tha peared because n 21% 23%* EBRI focus 20% es solely on employee benefits research — no lobbying 7.5%or advocacy financi interest i levels among t al i nn c cen han th ives to pa gin ose wit g doctors h a rtici Hp D to one ate stil HP or CDHP. in l matt a seler to a Sixty ect net 18% -ll i one per wn ork c dividuals, r o cent mbine of18%* e tra d gar with dditi le oss of p lower nal, 4 cost sha 4 lan perc type. Un ent of ring, 19% CDHP, like and ther in 2 a 009, nd e w 32 fi ere nancial pe no stat rcent of istically handful Figure 6, of Cost em-Conscious Decision ployers began 20%* to offer Maki healt ng,h by reim Type of H bursement arra ealth Plan, ngements (H 2010 20% ........................................................ RAs). In 2004, employers were able ........... 9 to start amount of money that is placed in the a20% ccount, the level of the 7.3% deductible, and the comprehensive 31%ness of the health Figure EBR 28, I E An mploye nual I e Ben ndivi efit R dua esela Contri rch In17% stitbutions ute Issue B to the rief (IS Accou SN 0887 nt ?, by Hous 137X) is pue bli hsol he d Incom d monthly b e, Am y the E ong mploy Pers ee B ons ene fit With Res CDHP, earch Insti tut e, 8% 30% 20% 40% 19% or-lose-it (Employee Benefit Researc rul 20%e associated with HSAs, as a You You h In do not believ do not believ stitute, S ny money l e e it w it will ill ehelp ptember 20 help y yo oe u uft i 5% 5% n the accou 16%04). 18% 18% nt at the end of the year automatically rolls over income, an 20% 30% d race. The response rate was 25.9 percent (20 percent for the base sample or national sample, and In theory, ? Nine percent r the incentives eported that it of CDHPs are was designe either todo co to prom mplicat ote he ed or they ightenedi dd no sensitivity t understand t to cost and quali he option. ty in people’s With respect t $1,0 As the C 0quality 0 to th D30% HP and H satisfa e o account, familiarity ction incr DHP markets continue wher wie eas in 11% th a C ased signific dividuals DHP, 56 perc antly to expand and more with among t fam ent oily co f th hose with ose verage 2 11% wi th C enroll are a D CDHP were mo HPs. ees are enrolled re like The lgap in satisfaction r y tha extremely or v n t for lon hose wit ger eh ry familiar peri sin ates for qua g ods of t le covera with ime, t ge lity of it to (Fi he gure [IF 11 Q1 = 1, 00 30% 13th S EBRI stand t5, SKIP T . NW, Suite 8s alone in em H 78,E OTHER 2 Washington, Dpl C QUESTIONS] oyee ben , 20005-4051, efits rese at $300 pear r ye ch a ar or sis an inde included as pend part eof nt, nonprofit, and no a membership subscr 6.3% iption. npa Pe rtisan riodi- 20% 6.1% 6.1% 6.1% 6.1% incentives offeri s HDHP e ignific ng hea ant dif nrolle did lth feerences not seem to s pla were ns wit e by pla xtrem h h m en alth saving ely or v atter more to individuals type (Fi ery like gure s accounts ( 18 ly to stay w ). HSAs enr ith)o their .lled By in pl 200 CDHPs an 9, if t 1h 5.ey ha p It was fou ercent d th of e o e nd that i pportu mployers nity to ndivi with dua switch 10 ls are mor –499 plans. work e lik ers ely to 11 insurance are all subject to variation. Employers often cover certain preventive services in full, not subjecting them to Report availability: By Paul Fronstin, Employee Benefit Research Institute This report is available on the Internet at www .ebri.org 16%* 2010 ....................................................................................................................................................... 28 5.5% 15% and In theory, a ra cal is availa s po15% sta 30% g bl e You You e in random sample of 2,000 yields a te ar ar the e wor e wor paid i fol r riied that y ed that y n W low ashing y our our ingt employ employ one , D ar. er er C ,will k will k and a now y now y dditi our our statistical prec o nal per per mail s sonal onal ing office ision of plus or s. POSTMASTERminus 2.2 percentage points (with 95 percent : Send address changes to: EBRI Issue Brief, 1100 34 percent 15% for the oversample). The margin of error for the national sample was ±2.2 percent. decisions a6% 6% boorga ut thei nization. It analyzes a r health care. Yet the nd rep ability o ortfs re peosea ple to mak rch data e iwithout spin o nformed decisio r unde ns is hi rlying a ghly de gend 15% 15% pena. All fin dent on t dh ing e s, Figure 7, Trends in Cost-Conscious Decision Making, by Type of Health Plan, 2005–2010 ......................................... 3 . 12 5). contribut sustained In co care rema ntrast, 10 e at 15% impact that these least $2, ined bet percent 00 w0 ee (F o n tra p figure in lans are having divi di 2 tional e duals 9). Ove w nrolle irall, 3 th tra on cost, es0 d and HDHP itional percqen u 8% 8% co ality, an t of i verage were extr en ndivi rollees. 12% 12% d acc duae ls The ss to health with dif emely or sin fere gle co n ca ces i very famil re services verage contri n overall satisfa iar wil with buted at l l be better a CDH ction lev eP ast , eand ls by 15% 15% 10% 10% 15% 30% 13% 13% report that they wou 13% ld probhealth infor ably health inforon partici mation p9% ate in wellness program when their costs were reduced, as compared with and 20 percen 15% t of employers with 500 or more workers offered either an HRA or HSA-eligible plan. (See pg. 39 for the deductible 13th St. N 20% W,. Employers c Suite 878, Washan of ingtonfer , DC comprehensive , 20005-4051. Copy he righ al t th insura 2010 by Em npce t loyeh e B at covers enefit Rese 100 percent arch Institute. A of h ll right ealth c s reserv are cost ed. No. 35 s after 2 12%* 13%* 12% 13% 13% ________. “The Future of Employment-Based Health Benefits: Have Employers Reached a Tipping Point?” EBRI confidence) of what the results would be if the entire population ages 21–64 with private health insurance coverage were whether on financial data, options, or tre 11% Figure 23 nds, are reve aling an 12% d reliable — the reason EBRI information is 2. Which of the following best describes your health plan's deductible: 11% extent to which they have access to usef $1,500–$1,999 ul information. 10 A s $2,0 understoo e perc ries 00, whi plan ent o a type fou q d. T ue le 39 perc f ih sn tions e six divi nduals d years o was in ent all as wit o pr fk those fh consumer eior y an d re HDHP e gar wit ars of t d h in en we fg amily h wheth gagem re e e sur cove xtremely v ee ey wer r i nt sur ra ndivi ge o contribut v e duals eys r very unch 10% reporte aange g familiar re ed at ed dd i or dis least n here th with e a provi $2,000 t 2 g a CDH 010 reed d survey: e a with var Po the account. . uni que Tr ious aditional base wa liys ne plan patients from w enrolle hich could es to Figure 29,20% Annual Individual Contributions to the Accou 2.5% nt, by Type of Coverage, Am 11% ong Persons With CDHP, 4% 10% 20% when detail their co ed explasts are incr nations of You already HR us eased. e As and H a differFor ent prinstan ogr SAs.) am that ce, 79 you 2.1% like percent better of 14% CDHP enro 11%llees would probably participate in a wellness the deductible has 10% been 10% met or th 9% ey may offer coverage with cost sharing after the deductible is met. If 10%* employers 20% 10% Figure In ord Issue B e8, Avai r to 10% 10% 10% qu 20% rief lalify ability , no for ta . 312 (Employee Benefit and Use of x-free contr Quality 7% ibut a ion ns d Cost I to an Research In HSA, nformthe i ation Prov stitute, Decem ndividual ided mus by He b ter 2007). be alth cover Plan a ed by a nd Effor hea Majort lth R to Find eas pla on n that has an To examin 10% e th the gold sta e issues me nnti dard fo oned above, r privat t e analysts a he sample wa nd de s divided into cision make one of thr rs, gove ee rnme groups: those nt policymake with rs, the media, and a consumer- 10% surveyed with complete accuracy. There are also other possible sources of error in all surveys that may be more serious than 10% 8%* HDHP or CDHP Offered 10% 8%* receive Health Care Us measure were more lik low futur er cost sharing (f e cha c ely than nges 8% e an in t CDH d Access Issues his evolvin indin Pgs sho and HDHP gw ty npe o in en Fifrollees to gure health 19 in ). be extrem Sixty surance. -two ely per or very satisfied wit cent of CDHP enrolle 8% hes, 6 the overal 1 perce l plan i nt of HD n all HP years 2010 .......................................................................................................................... 7% ............................. 28 SIXTH ANNUAL SURVEY: This Issue Brief presents findings from the 2010 EBRI/MGA Consumer Engagement in Health program This survey if the was made employ possi er offe ble red a with d suppo iscountrt from Am ed premium, ericwh an Ex ereas 7 press, Bl 0 peue Cross Bl rcent would ue if 7%* the Shiel em d Associa ployer increase tion, John d De pree m re iums & CDHP Main Reason for Deciding to Enroll in Current Health Plan, Among Individuals With choose to pay less than 100 percent of health car 56%* e expenses after the deductible 19% has been met, they then hav 23%* e the annual deduct 2%the publi ible of not l c. ess than Signing $1, up for 15 it tak 0 fo esr self a lot of wor -only co k verage and $2,300 for family coverage 10% (minimum deductible driven hea Information Fr lth plan (CDHP), om Other those wit Sources, 2010 h a high-de.......................................................................................... ductible 3% health 12% plan (HDHP), and those with 6%* traditional health............ 12 [A deductible The survey as ked i is the amount you have to f an individual’s health ppay be lan provide fore y 5% d io nur insuranc formation on e plan will start paying any part of y cost and quality of providers. Individua our medical ls were theoretical calculations of sampling error. These include refusals to be interviewed and other forms of nonresponse, the Minor Reason The Concerni study a ng le lso fin ngthd of t s thime t e follo hat CDHP wing: enrollees have had their account, 8 percent enrolled in the past six months, 5% 10% 5% enrolle of the survey. es, and 52 percent Differences in of traditio satisf nal action plan enro with out-o llees agreed that f-pocket costs may patients who explai are n a actively significpartici ant port patin ion o g in f the a pro gram Employers hav 5% e been interested i Not O n brin ffered gin a g aspects of consumer engagement into health plans for many years. As far Co., MetLife, 10% 5% 5% National Rural Electric Cooperative Association, Pfizer, Society for Human Resource Management, and The The Care S survey as urvey. 10% This study ked r a Choice o espon is de fbased on Heal nts who th Plan or in the No The Em ha and c onh plo line surv ronic co yee Benefi ey of nditit Research Institut n-Gro o ns 4,50 wh 8 up Mar ether privatel th ket, by Typ y insure ey a e (EB greed t RI) was founded in 1978. Its d ad e hul at they of He ts ages alth Pla careful 21–64 ly follo n, 2010 to provi 4% wed th mi ssion is to de na eir tionally for non ________. “A participvailability, C ants. Similarly ontribution , just over s, A 70 ccount Bal percent would pro ances, and Rollovers in Accou bably participate if either nt-Based Health Plans, drug or office visit cost sharing option o 10% f des 5%igning the plan with or without a maximum out-of-pocket limit. 4% 4% 5% bills.] amounts are increasing to $1,200 and $2,400 in 2010). Certain preventive services can be covered in full and are not coverage. Ind 0% ividuals were assigned CDHP or HDHP to the CDHP and HDHP group if they had a deductible of at least $1,000 for Figure more likely to 30, Length o 0% 5% report t f Time With hat they ha CDH d, an P an d tr d ie Savings Acco d to use, qua ulity nt, 2 in010 formatio ............................................................................ n available than cost information, and both CDHP 29 another effects of ques 19 percent i tion wording a n the pa nst year, an d question d order, and scree 35 percent It costs too much in t n 5% h ing. While attempts are e past two 9% years (Fig $750–$999 ure 30). O made to minimize these factors, it is ne-quarter (28 percent) report 0% 3% c a b Commonwealth Fund. back as to maintain diff1978, ere or nce improve they a in overall satisfact dopted their healt Sec. 125 cafet h ion rates contribute to should pay bet eria , to encourag w plans a less for een traditio n h d fl ealth e, an enal xible s c pla d to enhanc are ser n p, HDHP, ending vices than e the developmen accounts. and C a Dpatient HP More rec enrt of sound empl o who llees. e is ntly, not parti employ ocyipati ee ben ers ha ng i eve fit n the Figure 9, Employer Offers Wellness Pro a33% gram, by Type of Health Pla b n a, 2010 ...................................................... b c c ........ 13 treatment r representative data egimens for regarding the specific con grow ditioth ns. of consumer There was no -driven h signife icant alth pl var ans (C iation i DHPs) a n the fr neque d high-deduc ncy witht ible which hea peopl lth pl eans with was 2006 reduced, wher - 0% 2009.” EBRI Note eas less than 60 perc s, no. 11 (Empl ent woul oyee Benefit d partici 0.2%pate if Research In cost sharing for d stitute, Nro ugs or vember 2009): 2–12. office visits was increased. 0% Traditional HDHP 9% CDHP EBRI explo 0% res the breadth of emplo Traditional yee benefits and related issues Traditional HDHP HDHP CDHP CDHP 2% subject to t ? Individuals i he ded nu CDHPs were ctible. The out more likely -of-pocket maximum than those with may not e traditional cov xceed $5, e80 rage to 0 for sel exhibit a number of cost-conscious f-only coverage and $11,600 for individual coverage or $2,000 for family coverage. To be assign 1% ed to the CDHP group, they must also have an account, and H Who we are DHP enrollees were less likely than traditional plan enrollees to report that the plan provided the information. impossible to quantify the errors that may result from them. being in the account three to four years programs and so , and 8 perce und public policy nt report havin through objective g the account resear for five years or ch and education. EBR more. I is the only 0% 0% 0% Less Than One Year 1–2 Years 3–4 Years 5 Years or More program. The dif You fere feel nce employ bet ersw seen hould bot not offer h C this D ty HP an pe of prd HDH ogram P 6% enrollees vs. traditional plan enrollees was statistically continued to -2% turn their att Allergies ention to co Health Risk nsu Asses Am rthritis sm er en ent gagement Depressio in health n care more High Cholesterol Health Pr broa omotion dly. In Pr 2 ogr0 am 01H , t ypertensio hey form n ed a There is no statutory requirement that an -1.1% employee have a high-deductible health plan in order to also have an HRA. chronic co (HDHPs), an ndit Lower d ithe im ons follo cost of the pact o wed t premium f these heir tr plans a eatment n regimens ac d consumer e ro nss plan ty gagement 36% pes mo , with re genera one 41% e lly x con the eption behavi (Figure 51%* or and attitu 38). General des of ly, the Figure 31, No deductible Am 0% 0%EBRI studie ount Curr Source: EBRI/Commonwe ently s the worl in Acco alth Fd of health and retirement ben und Cons unt, Am umer ong Persons Wit ism in Health Care Surh vey C , D 2005- HP, efit 2007; EBRI/MG 2010 s — issue ......................................................... A Cons s such a umer Engagement s 401(k)s, IRAs, retire in Health Care ment ..... 29 Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005-2007; EBRI/MGA Consumer Engagement in Health Care 0% family cover behaviors. age, wit They w h thee re mor deducti e likely to say bprivat le counti e, nonprof ng to that they ward this it, nonpar had tisan limit. ch , Washington, DC-b ecked wh The minether their imum allo ased organi wabl plan e dedu wo zatuld ion com ctibl cover car e m a itted exclusivel nd ma e; asked ximum y for a out- to such as a health savings Extr Reduc emely ed Dr Interug acc estCos edount t Shar Lower Cost Ver (HSA) or ing y Interes Sharing Inc ted rhealth eased Somewhat Crug Cos reimtInter bu Shar rs es ing ement arra ted R Not Ver educed O y Inter n ffic ge ement es Vis ted it Cos (H Not at All H t Shar igher Cost RA) with ingInter Inc Sharing res eas t a ed ed rollover provision Office Vis Don't Know it Cost Sharing that they Nearly 30 perc 0% ent of HDHP 0% 10% enrollees 20%reported ac 30% cess to 40% quality i 50%nformat 60% ion, compa 70% red with 80% 34 perc 90% ent of CDHP 100% Figure ? As befor 10, Individual e, this year’s surv Participates in ey finds Welln that i ess Program O ndividuals in ffe Cre DH d P by Empl s and HDHPs oyer, Among were le Thos ss likel e O y than t ffered a hose i Weln lnes traditional s Survey, 2008-2010. Sur S Source: vey, 2008- EBRI/MGA EBRI/MGA 2010. C Consumer E Engagementt iin H Health lth C Care S Survey, 2010 2010. ________. “S coalition to significant. S report h Low out-of imilar support ources of Cov Nothing e-alth pocke ca t co was fou re provi e Les sts f rage and Ch s To han $500 r the No n dd for er Choic qu doctor e indivi ality measur aracteristic $500–$999 duals wh es, s of o follo $1,000–$1,499 and today the Unin w their t 36 th sure gro reatment $1,500–$1,999 ed: Analysi up is co 14* regimen. Abo smposed of the Mar $2,000 or Choice Mor not o eut ch 2 40 percent nly of Don't 9* 010 Current employers but Know of However, it is 0%incom standard pract e adequacy, co ice amon nsu g m em er-drive ployers that $1,000–$1,499 n benefits, Socia an employee l Security, tax treatment of both retireme must also choose a high-deductible health nt and health plan in 12 201 adults 0 fin with d Individual or Single Coverage in pri gs Low are in vate hea er cos contrast t shlar th ing in for surance cove to somew active Low hat err c age. mixed ost sh aring findi for pat ngs ient sin 20 Low07 er c (Fron ost sharis ng tin and for scient Coll ificallin y s, 200 Lower co8). st shari Inng 2f007, or high-qual peopl ity e in a public policy research 0%and edu 10%cation on 20% econ 30% omic securi 40% ty a50% nd emplo 60% yee be70% nefit issues. -4% a a Less Than 6 Months 6 Months to Less Than 1–2 Years 3–4 Years 5 or More Years Don't Know Concerni of-pock Permitted insurance also includes workers’ gene et lim ng ric ac it dru count balanc are Traditio g iindexe nsnal tead o  = He dalt t e, fh o a  plan infl 7 perc br  with and ation.  ent had noname;  deNe ducttwork plans m icompensation, ble tal no balanc  ork  <$1,000 ed to (indiv their e w ay idual), hile 18 tort liabil d impose o  <$20,00 ctor about percen ities, a hi  (family). gher t had $ tr n  d liabi eatment o deducti 3 lities rel ,00 ble 0 p s and out-o or more tio ated to ownership or the use ns and (Figu cos f-pocket limits rte 3 s; develo 1). Overall, pefo d a r out- of can use to paTraditio y for m Traditional nal = e   =He dica  Health althl  plan expenses or t  plan  with  with  no  no  de  deductible ductible he a  or  or  <$1,000 b  <$1,000 ility to ta  (indiv  (individual), idual), ke th  <$20,00  <$20,00 eir accou  (fam  (family). ily). n t wit   h them should they change jobs. Individuals enrollees and Sour 45 ce: perc EBRI/MG ent o A Cons f traditional umer Engagement plan enro in Health Car llees 25% e Sur (Fi veyg , 2010. ure 8). Similarly, just one-quarter of HDHP enrollees reported Program, by Type of Health Plan, 2010 4 ...................................................................................................... 13 Table of Contents plans to S S both ource: patient Nothing EBRI/MGA EBRI/MGA srecommend th in we llnes C C s Les onsumer prs ogram Than E E eir h ngagemen $100–$299 e fol alth low tt iiin ng t pl H Hea ra eat lth lth n$300–$499 m to a C Cent are regi S Sfriend or urvey, mens 2010 2010 $500–$999 . co-worker prov $1,000–$1,499 en eff an ectivd to stay with t e ca $1,500–$1,999 re $2,000 heir c or Mor doc urrent te ors Don't Know health plan if Figure 32, Am Sour Sour Sour ount Rolled O cc e: e: cEBRI/MG e: EBRI/MG EBRI/MG A A Cons Cons A Cons vumer er from umer umer Engagement Engagement Engagement Past in Health Year, in Health in Health 2010 Car Car Car e Sur e Sur e Sur ............................................................................ vv ey ey v , 2010. ey , 2010. , 2010. .................. 32 Good ne Sour b  ce: EBRI/MG twork of A physicians Consumer Engagement and 1 Year hospitals/do in Health Car cto e Sur r vey, 2010. indivi Populati duals th bon Su  Sour benefits, cost bo   ught ce: EBRI/MG rvey.” that pati AEB Cons manage ents usin RI Issu umer Engagement e Brief, ment g sci, worker a ein Health ntific no. 347 (Employee Benefit Research Insti ally Care Sur prov nd vemploye ey en , 2010. effective r attitude care shoul s, policy reform p d have low tute, Sep er cost s roposals, and p th emb aring, er 2010). while ens about ion assets Opinions About Provider Engagement also of co nsumer gro aMy deductible is less th HDHP = ups High- a deduct nd or ibleganiz  healt EBRI’s member h plan ed an $ la  with bor. 1 ,000 deduct I ible ship includes a n  20 $1,000+ 05,  (indiv employers idual), cross-section of  $2,000+ sta  (fam rted to ily),pension funds; businesses; trade associations  no focus  account. o   n value-based insurance designs ; order to have HD HDHP an HRA. 1988 HP =  =High  1989 High -de -deductible 1990 ductible 1991  he  health alt 1992 h plan  plan 1993  with  with  de 1994  deductible duct1995 ible $1,000+  $1,000+ 1996  1997 (indiv  (individual), idual), 1998  $2,000+ 1999  $2,000+ 2000  (fam  (family), 2001 ily), no  no 2002  account.  account. 2003     2004 2005 2006 2007 2008 2009 CDHPs with ar aTraditio thritis an nal = Hed hy alth plan pertension  with no deduct wer iblee  or sign  <$1,000 ifica  (indiv ntly idual), less likely to  <$20,00 (family). say that they   followed their treatment regimens aa a aTraditional = Health plan $100  with no deductible or <$1,000 (individual), <$20,00 (family).  property (such as auto aTraditio Traditio Traditio Sournal cnal e: nal  =  EBRI/MG =  mo He   He = alt He alt bile insurance) halt h  plan  plan A h  plan Cons  with  with  with umer  no  no   no de   de Engagement  duct de duct .duct ible ible ible  or  or   <$1,000  or in Health <$1,000  <$1,000  (indiv  (indiv Car  (indiv e Sur idual), idual), idual), vey  <$20,00  <$20,00 , 2010.  <$20,00  (family).  (family).  (family).      47 of-network ser perc budget ent ha to ma d less than Traditio vices nage nal . An i  = He hea n alt $1,000 in the ac div h plan lth c idual  with are e can  no de x have a h duct penses; and use ible count at  or <$1,000 ealth the time  (indiv pla didual), n a with n  of online <$20,00 the a deductible and maximum ou   s (family). cost-tra urvey, an   cking tool. d 10 per cent didt-o not k f-pocket limit now how m tha uct h was with only a fl in the network eTraditio xc ible spending account nal = Health plan with no de (FSA ductible )  or were  <$1,000 not  (indiv incl idual), ude  <$20,00 d i42 n th  (family). e CDHP   group. 40 26* access to cost informat c c  ion, compared with 30 percent among CDHP enrollees and 41 percent among traditional plan they habd t   h CDHP e o  =pportu  Consume nity to r-driven he switch alth plan plans. with deduct ible $1,000+ (individual), $2,000+ (family), with account. ENROLLMENT CDHP and fundi CDHP LOW BUT GR  =  =Co  Consumer nsum ng. There is wi er-driv -driven OWING: en he  health althlabor un  plan  plan The s  with de  with spread  ions; h de  u deductible duct rvey fi ible ealth  re $1,000+  nds co $1,000+ cog car e prov (indiv n  (individual), ition that if employee be ntinue idual), iders and insur d slo  $2,000+  $2,000+ w  (family),  growth i (family), ers;  with  with government org  n account.  account. co nnsumer-driven efits data exist, EBRI kno anizations; heand service firms. alth plans: w In s it. 20 10, bbHD    b HP a  = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account.  b  that seek to 30 percent t e h Sour My deductible is $1,000 or bHD HDHP ought t  nHD courage th HP cTraditio e: HP   ==EBRI/MG    High High = High hnal -ere -de deductible - de =duct A  He s duct e Cons h alt ible use of ould be lo ihble umer    plan he health  he alt   alt with h Engagement hi   plan plan h plan  gh-va no   with with we  de  with duct  r cost sh  de deductible more lue servic in Health  de duct ible duct  ior ble i ble <$1,000   Car $1,000+ $1,000+ arin  $1,000+ e Sur es w g  (indiv   (indiv for v(individual), ey  hile (indiv , 2010. idual), idual), patients using high-qual idual), discoura  <$20,00   $2,000+ $2,000+  $2,000+  (family).   gi (family), (family),  (family), ng t    he  no no  no   account. account. use of  account.   ity  services wh doctors. en the benefits are not HD b  HP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account.  for the The 20i10 r co EBR ndiHD tIions caref /MGA HP = High Cons -deully. duct um ible But er Eng  healt peo h plan agem p le with in ent i  de CDHPs wit duct n Hea ible $1,000+ lth hCare   (indiv depr idual), S ession urvey i  $2,000+ wer n  (family), clude e sign d  no qu ifica  account. esntions tly   more like regardin ly to g the im say they fo portancllo e of wed HD * Differenc HP = High e -de between ductible HDHP/CDHP  health plan with and  Traditional deductible is $1,000+ statistic  (indiv ally sidual), ignificant  $2,000+ at p = (family), 0.05 or better  no account. .   Figure 11, Rea Sour * Differenc c  ce:s E ons for BRI/M e G between A Cons Not P um HDHP/CDHP erarticipati Engagement and n in Heal g in Traditional th Car Employers e isS s ur tatis veytic , 2010. ally We signific llness Pro ant at p = 0.05 or gram Among Tho better. se Offered but Not Participating Prior exp Sour * Difference between HDHP/CDHP cSour e: EBRI/MG c erience e: EBRI/MG A Cons with the plan A umer Cons umer Engagement and Engagement Traditional in Health in Health is Car statistically significant at e Sur Carv e Sur ey, 2010. vey, 2010. 27 p = 0.05 or better. 22 15* quali Figure 33, in the accou fies them Per n acCDHP   t to make centage . Concern b   = Consum Extr a ta ing r er-driv emely xe o -nfre llovers, 13  healt e contr or Very h plan with ibut percent Satisfied With Quality  deion to a ductible rolle  $1,000+ n HSA, d o  (indiv v bu er idual), nothi t the  $2,000+ ofn in Hea g w divi  (family), lth Care hile dual 39  with is not percen R  account. ecei required to mak v t rolle ed, by Ty d over pe a of Healt t e least a contri $1,0 h P bution lan 00, at the nor c c Sour c  ce: EBRI/MGA Consumer Engagement in Health Care Survey, 2010. enrollees. cCDHP CDHP   HD   = =HP   Consumer Co  = nsum  Highe-rde - -driven driv duct enible   health he alt hehalt   plan plan h plan   with with  with   deductible de duct deduct ibleible   $1,000+ $1,000+  $1,000+   (individual), (indiv  (indiv idual), idual),   $2,000+ $2,000+  $2,000+   (family), (family),  (family),   with with  no   account. account.  account.  Introductio a n .................................................................................................................. CDHP cCDHP   CDHP  =  =  Co   Co = nsum Co nsum nsum eerr -driv -edriv r-driv eenn  he e  he nalt  he althalt h  plan  plan h plan  with  with  with  de  de  duct de duct duct ible ible ible  $1,000+  $1,000+  $1,000+  (indiv  (indiv  (indiv idual), idual), idual),  $2,000+  $2,000+  $2,000+  (family),  (family),  (family),  with  with  with  account.  account.  account. ........................................ 5  Fronstin 5 percent , P of a t ul Sour h CDHP , and S e cpopu e:  =EBRI/MG  Consum lation ara R. e Ar -Cons driv was enro Collins. “ eumer n healt Engagement h plan lle F  with d i indings From n  de in Health a C ductD ible HP, Car  $1,000+ e Sur up th v  e 2007 EBRI/C (indiv ey from 4 , 2010. idual), percen  $2,000+ (family), t in ommonwealth Fund Consu 20  with 09.  account. Enrollment in HDHPs increase merism in Health d from 13 HRAs are ty Tpic radi a CDHP tally set i^ onal Es timate = =  Co Healt nsum is up as h pla se tatis rn -driv wi tic th notional ally e no n he differ dealt duc h ent  tplan ible o fr arran om the pr  with r <$1,  de gements 000 duct ior (i y ndiv ible ear idual)   $1,000+ shown at the p and , <$20,  (indiv exis 00 (fidual), am t only = 0.05 or ily).  $2,000+ on better  paper. Em (family), .  with account. ployees may view the account as if ^ Don’t know Estimate is statisticamount of indi ally different from the pr vidual deducti ior year shown at the p ble = 0.05 or better. CDHP a  = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. justified by the costs ( * Difference between Chern HDHP/CDHP ew et al., and 2007). Traditional is statistically significant at the p = 0.05 or better. Only Medicare Specific benefit * Differ CDHP = c enrollees ages 65 and older a   ence Cons between <$50,000 and umer-driv s offered b en health y the pl $50,000+ is plan an with deduc re allowed to p statis tible $1,000+ tically signific (indiv ant at ay insura idual), the 18 p $2,000+ = 0.05 or nce pr (family better emiums from a ), . with ac 17 count. n HSA. A Medic 11* are enrollee under various ways i their tr ? Indivi eatmen b duals * Differenc * aDifference between HDHP/CDHP  * Differenc n t regimens car which wee re slightly mor between e provi between HDHP/CDHP d HDHP/CDHP e ers of h fullye than like and and ealth and l Traditional did those Traditional y to r Traditional care servic eport that th is is s is statistically significant at t s atis with tatis tices tic ally tra ally en si gnific sd ey h iga gnific itional ant ge their ant ad at p at the p covera provider qu = = 0.05 or 0.05 or patients. Eighty p = 0.05 or better ge. better. . better ality . informati -one per on than cent they of traditional plan did cost Individuals in Pro we * Differenc re as gram, CDHP e s  = between ign 2010  Consum ed to HDHP/CDHP .............................................................................................................. er- the driven HDHP  healt and h plan Traditional gro  with up i  deisduct f s t tatis hey ible tic  $1,000+ adid lly si gnific no  (indiv t have ant idual), at p = an  $2,000+ 0.05 or account use better  (family), .  with account. d for health care expenses ....................... with a 15 HDSource: Mercer National Survey of H * Differenc CDHP P# =Differ Hig  =h  Co -enc dedu e nsum between e between ctibl er e - heal driv HDHP/CDHP e 2005 thn   plan healt and wiht hplan 2010 is Employer-Spons d and educ  with Traditional tis ble t atis de $1, duct tic 000+ ally is iore ble s s (td   iiatis gnific $1,000+ ndiv Health Plans and tic idua ant ally l)  (indiv at ,s $2, ignific p 000 =idual), 0.05 or ant + (Bureau fam at p  $2,000+ il better y = ), no ac 0.05 or of .Labor  (family), count better Statistics. .  with .  account. 2005–2010 ..................................................................................................................... # * Differenc Difference between e between 2005 HDHP/CDHP and 2010 is and st Traditional atistically sis ignific statis ant tically at p s =ignific 0.05 or ant better at the . p = 0.05 or better. ......................... 32 open end ? of an There 20 accou 10 w (Fig as no nt. ure signific 32). ant variation in the frequency with which people with chronic conditions followed their EBRI delivers a steady stream of invaluable research and anal EBRI’s work advances knowledge and understanding of emplo ysis yee benefits and their Survey.” c EBRI Issue Brief, no. 215 (Employee Benefit Research Institute, March 2008). 13 percent Family Cover in 2009 to 14 age percent in 2010. The 5 percent of the population with a CDHP represents 5.7 million adults Summary of Findings money was ac CDHP tually = Consum bein ........................................................................................................... er-drg iven h deposited into ealth plan with deduc an accou tible $1,000+ (n indi t, vibut em dual), $2,000+ ployers (family), wi do not th account incu . r expenses associated wit .................................. 5 h the   Plan's good reputation, recommended by others 10 12 6* enrollees age 65 cannot use an HSA to pay insur and nearly 90 percent of bot ance h HD premiums. HP and CDHP enrollees reported that it was extremely or very important information, and both CDHP and HDHP enrollees were less likely than traditional plan enrollees to report that the rollover provision or * Difference betwportabili een HDHP/Cty if t DHP and T hey raditc ional han isged jobs. T statistically significhis ant at grou p = 0.05 or p in be clu tterd . es individuals with HSA-eligible health plans but CDHP, HDHP, and traditional plan e importance to nrollees werth ee nation’s econo about equally my likely among policy to use informati makers, othe news n providmedia, and ed by their the public. It health plans. treatment regimen across plan types, with one exception. EBRI publications include in-depth coverage of key issues and trends; summaries of research Prescription drug My deductible is less th coverage an $2,000 for me and my famil 35 y 20* 10* This ages 21–64 Health St Issue Brief wi atus and Demographics th presents private fin insu drance, whil ings from the e th 20 e 14 perc 10 EBRIent wi /MGA Consum th a HDHP er rEngagement epresents 17. in 2 mill Healt ion h Car peoep lSurvey. T e. Amonghis s the t17.2 udy is arrangement until an employee incurs a claim. By contrast, were employers to set up the HRA on a funded basis, they Figure In 2007, th 12, Per e scentage of In urvey found tdividuals hat adults Repor with CDHPs ting That and ThHDHPs ey Wouwere s ld Proba igni bly Part ficantly icipat more likely to r e in Employer eport that th Wellness Pro ey h gram, ad Figure 34, Percentage Extremely or Very Satisfied With Overall Health Plan, by Type of Health Plan, 2005–2010 ......... 33 Cost-Conscious Behavior ....................................................................................................... does this by conducting and publishing policy research, analysis, and ............................... 10 special reports on   Both in that the plan provided divi ir doct duaor communica ls and em cost or quality ployers are ted with informat allow them ed to co so that t ion. Inntribut terms o hey c eo to a fuld the n r use o e HSA. ally un fContributio in derstand w formation provide ns hat are e thex doctor clu d by dehealth d wa from taxa s saying plans, CDHP ble (Figu income if re 14). may also include individuals with high-deductibles who are not eligible to contribute to an HSA. Individuals with However, C What we do DHP and HDHP enrollees were more likely than traditional plan enrollees to try to find information on cost findings and policy developments; timely factsheets on hot topics; regular updates on legislative and Tayl or, Humphrey. “Do Familiar type of es I covn era ternet ge, simple to unders Research ‘W tand ork’? Comp aring 21 Online Survey Results With Teleph 20 9* one Surveys.” My deductible is $2,000 or more for me and my family million based on a individuals wit n online survey o h an HD f 4, HP, 3 508 7private percen ly insure t (or 6.3 mil d adlul iots ages n) report 21 ed t -64 to provide na hat they were eligi tionally r ble for e an pres HSA but entative di data d n ot would inc by Var ur the f ious ull Financial I expense at the ncent time ives and Ty of the contr pe of Healt ibution h, eve Plan, n i 2010 f an e ................................................................. mployee had not incurred any expenses. ... 15 avoid Figure ed 20 cont , skippe ains data d, or delayed he on various demogr alth ca emplo re y ee benef because o aphici an ts issues; holding educational br fd h cost eals than th status variab were those wi les iefings for EBRI memb from each of the surveys cond th more traditional co ers, congressional and verage. In ucted 2008, While not large, the difference between traditional plan enrollees and CDHP and HDHP enrollees was statistically Satisfaction and Attitudes made ? This year enrolle by the es, HD Easy e’s sur mployer a acce regul HP enrol vss t ey fin atory de ond care d d ls very ees, e ducti velopment and tra few ble instanc from ditio s; comp adj nal es pla us wher ted re n e gros hen e th nrolle si e sve refere income es wer per18 centage of in e if m nce resou equa ade lly lby th dividuals r ikely to r rces o 15 e indi n benefit pro ee port vidual. port that t ing t Thh e m hat th ey ma grams an 7* aximum a ey de or a family use of d wo nnu th rkforce al e traditional Trends ........................................................................................................................ health coverage include a broad range of plan types, including health maintenanc.................................... 11 e organizations (HMOs),   and quality from sources other than the health plan. Specifically, about one-quarter of CDHP and HDHP enrollees Internati Don’t know onal Journaamount of f l of Market Research amily deductible . Vol. 42, no. 1 (August 2003). Figure 35, Percentage Extremely or Very Satisfied With Out-of-Pocket Health Care Costs, by Type of Health Plan, federal agency staff, and the news media; and sponsoring public opinion surveys on employee have such regarding th an e account. Over growth of acco all, 1 unt-based he 2.1 million adults a alth plans a ges nd high- 21–64 wit deducti h pri bvle h ate insura ealth pla nce ns, repr (HDH esentin Ps), and g 9.5 theperc impact ent o of f that these betw HDHP e een nrolle 2005 e and s continue 2010. T d to hese data be more may likely than tr explain some aditio of the nal plan differen enrollces in ees to r behavio eport tr and attitu hat they hades d delayed or avoi that were obsded erved Opportunity to issues; sa and major survey ve money in the account, rollover s of public attitudes. contributio signific member information. ant. S n is li delay g $3, htly mor C 05 D e0 for d or HP an e th avoided sel d H an 7 f-only D0 H P perc gettin covera enro ent g llees health g of in e an we divi d re also mor care $6,1 duals r due to the cost inc 50 f eo ported th r family e likely to try to cove at it was rage reas fextrem ed or ind in 20 informat decreas 10. ely or very ioe nd. abo impo ut th rtant that eir doctor’s cost their preferred provider organizations (PPOs), other managed care plans, and plans with a broad variety of cost-sharing sought oth Don't know i er sources of f have deductible information, while one-fifth of traditional plan enrollees did so. Respondents were asked a series of qu benefit issues. estions regarding their EBRI’s Education and Re attitudes toward th search Fund eir (EBRI-ERF) performs health plan and satisfactio the charit nable with , Figure 13, Percentage of Individuals Reporting They Would Probably Participate in Employer Wellness Program, HRAs can Availability be thought and Use o of as providin f Cost and Q g u“first-dollar ality Information ” covera .......................................................................... ge until funds in the account are exhausted. Leftov ................. 11 er funds at   2005–2010 .............................................................................................................................................. 33 market, were plans and con funds fo s either umer en r futu in a C re years gage DHP or ment more were in ge an HDHP nerally on that the was eli behavior 4 gib an le fo d attitudes o r an HSA but 3 f ad had ults with not o priva pened th 46* te he e acco alth insur unt. ance betw gettin een g a tradit ny n e EBRI ede ional d h plan ealth enr care services omeetings llees, HDH present an because o P enrolle d explore i es, an f cost d CDHP s s, but t sues enrol with he dif thou lees, as pr ference ght leade betw esent e rs from all se een tra d in d Fi itiona gures l ctors. plan 5–19. In enrol all lees buand t one doctor work with them to find realistic changes that they could make to improve their health, while about 70 percent or and quality from sources otheeduca r thationa n thl, and e health scientif plan. ic func tions of the Institute. EBRI-ERF is a tax-exempt organization arrangements. The shared characteristic of this group is that they either have no deductible or deductibles that are regard to various aspects of their health care. Questions were asked about overall satisfaction with the health plan as by Various Cost Sharing Incentives and Type of Health Plan, 2010 .............................................................. 16 the end of each year can be carried over to the following year (at the employer’s discretion), allowing employees to Puts you in control of your health care dollars, you coverage. Choi Participat ce of Health Plan, Premiums, and Reasons for Choosi Th ion in e sample Wellness Pr was randomly ograms ............................................................................................ drawn from Synovate’s online panel of more tha ng Plan n 2 million Inte........................ 11 rnet users who   EBRI regularly provides congressional testimony, and briefs policymakers, member organizations, year (20 CDHP disappe 09), Cared, mostly DHP enrollees wer because o e mor f th e lik e signific ely than ant i tran dcr itiease onal in plan the enro percentage of llees to self tr -re aditional port bein plan g in enrolle excellees re nt orpo ver rting y The To be remain eligibl der e for an of this re HSA, i port ndexamin ividuals may supported b es thenot be e findings y contributions nfrom rolled in t and g he other h 201 rants. 0 EB eal RI/MGA Consum th coverage, suech as a r Engageme spouse’s pla nt in Henalth , unless that Care 3. Do you have a special account or fund you can uFigure 37 Figure 22 se to pay for medical expenses? The accounts are Fig Participatio slightly l ure 36, ess re Perc ported that n in Wellness Programs entage Extr it em was extr ely or Very emely Likely to or very impor Recommend Figure 29 tant that Healt their h Pla doctor w n to Fri ae sn 1 d) or acces Co-s W ible orke by r, by phone; Type 2 of ) too k below current thresholds that would quality for HSA tax Figure 12 Figure 14 Figure 25 preference, and that they do not have an HRA-based plan. MORE COST-C make ONSCIOU choices of S BE how yo HAV ur a IOR: ccoun Individuals in C t is spent D Figure 31 Figure 33 Figure 35 Figure 16 H Figure 18 Figure 6 Figure 4 Ps wer4 e more likely tha4 n those with traditional covera 25* ge to well as satisfaction related to quality of care received, o Figure 27 ut-of-pocket expenses, and choice of doctor. Roughly three- Figure 2 Figure 10 accumulate funds over time, and, in principle, creating the key incentive for individuals to make 9 health care purchases and the media on employer benefits. have agreed to participate in research surveys. This survey used a base sample of 1,996 to draw incidence rates for Survey as t good plan Among i access issues ? is also a CDHP e healt ndivi h h. T ey relate to n d high d rolle u hu als e survey e to costs. - covere ededuct s were P also differences er d ibl more centa b N ey asked r o signif he an li alth ge of kely than employm and si icant pla eIndividuals spon n. access issues milarities amo However tradi e dents nt-btas ional whet Co ed , vered b indi hea her plan were found between v nliduals ar they g i th enr y plan, t n Emplo divi ohad chro lle dua e a es to hy ose lls ment loenrolle repor wed to h in nic con -Based Health CDHPs tCDH d that they ha d in tra ave itions. Pwer esupplem d nitional e rollees In more Benefits some yea d he ental th likely and tr e o alth pportu coverage t pla aditional hran those sn (altho s, CDHPs nity to wit plan ugh w h fill out a i ,th no and out t in a Opinions sometimes referred to as Health S About Provider En Percenta gageme ge Extremel Pent rcentag ............................................................................................ avings ey of I or Account ndi Vevi ry dual Likel s (H s Wi y to Sta SAs) th Empl , He y o alth With yer Reimburs Contr Current ibutieme on Health n at Account Plan If s ( ....................... 14 HRAs), Personal   Figure Endnotes 14, Agreement With Statements A Annual bIndividual Contrib out Various Provider Enga u a tions gement Too to bthe Account, ls, by Ty pe of Health Plan, 2010 ....... 16 responsibility f Not much paperwork or coordinatin Percenta g th Agreement eir car ge of Individuals e with other With Statements provi Repor ders,ting spe 13 About cialis That ts, or testing f V The arious Pr y Would Pr 10 ov acilitie ider obab s; an ly d 3) un 6* derstood them Health Plan, 2005–2010 Amount Currentl Cost-Conscious Likelihood PeP Likelihood of Choosing Doctor b rcenta ercenta ........................................................................................................ geg of Changing Extremel ey Extremel Decision in Account, y or y to Select Netw Making, or V Among P eV ry e Satisfied ry Satisfied by y Te y Their Use of Health rpe of Health s ork ons With Out-of-P With Quality If Current Doctor With CDHP Plan, oc of , ke 2010 2010 t ................... 34 Distrib Ann Length of ution ual Emplo of Individuals Co Time yer Contrib With HRA vered b ution or HSA, s y to the Account, Priv 2005 ate Health –2010 quarters o exhibit a num f pla ber o n enro f cost-co llees, Individual Participates w nhether scious be enro havi lleors, such as h d in a traditio in Wellness Program nal aving c plan, hecked wh a CDHP, or an ether Offered thei HDHP, were by r pla Employer, n would co extremely or ver care; very asked for satisfied a Employers and insurers offer a number of different types of wellness benefits—programs designed to promote health EBRI issues press releases on newsworthy developments, and is among the most widely quoted responsibly. Employers can place restrictions on the amount that can be carried over. persons with account-based healthEBRI Issue B plans and H rD iefs HPs, an are period d the b icals providing exp ase sample was ert evaluati comp aleme ons of emplo nted wit yee benefit issues and h an additional to Account, Among Persons With Employment- 201 enrolle traditional 0), care acc the es duri cov sur o ng 20 e v unts, Person rage ey foun 08, exc to d t have (Ph er e at al medical funds, pt centage With a choice individu amon a Choice of g high pri of als in vatel hee y i alth of Heal CDHPs w r-incom nsur or Choice fund plan, ed th Plan, adul e efollo ire n ts 21–64 di sig viduals, wed by bnif y T w s, icantly ype ho and are dif those but H reof ceiless likely Health Plan, ved D enrolle HP e healfth erent from employer-provi ncar rolle d to hav in H e i 2005 n es wer lD ast 12 m e HPs. Sixty-five – a healt 2010 e foun onths) hd t probl o be perc em than more ded Flexible ent o like w f C ely than re DHP HDHPs. Th high-deduct healthe r risk assessment, wh ibl Tax b eeport a for enefits of such t lso ex th hin a e plan m gs as vision bines consum y T ey reas they pe of Co ca er en wer re, dental vera e ga e g geme q eually , care Among n likel t more , speci y to re P 2 e gen fic rsport tha disea ons erally. It e With CDHP s aes, and t they xamin 4 insur had acc e,s health ance t 2010 ess to a h h care at pay decision 23* esalt a fi h promotio xed amo making, cost unt n Because the base sample Had Pa (n rtthe Oppor ational sam icipate Enga in Emplo g tunity pe le ment ) inclu y to Chang T er d ools, ed onl Wellness byy e 11 T , y b 7 i pe of y Pr n Tdivi ogram, ype of Health Plan, Health Plan, duals in a by V CDH arious Financial 2010 P and 2005 278 i –2010 ndividuals with a HDHP, Information Was Not in Select Netw Technology (HIT), ork, by b Ty y pe of Health Plan, Type of Plan, 2010 2010 Cost-Sharing as a person, with t Incentives he differ ....................................................................................................... eHealth Care nce Health Care bet ween Among P traditional Received, Costs, b e pla r b y s ons T y ny an T pe of Health yWith CDHP pe of Health d CDHP enrollees statist ,Plan, Plan, 2010 2005 2005 – ically signific 2010 –2010 ................................ 14 ant. About two-thirds of  Among Those Offered a Wellness Program, by Type of Health Plan, 2010 generic drug instead o sources o f a brn and em Insurance name; ployee be talked to n,y , b efits by all media. y T their yp ype of Health Plan doctor about pres,, 2005 cription a –2010 drug options and costs; talked to their with the choic 20% 50% e of doctor, and these results have been consistent since 2005 (results not shown). and to prevent disease. The 2010 EBRI/MGA Consumer Engagement in Health Care Survey examined availability and 80% trends, as well Based Heal as critical analy th Benefis ts es of and emplo CDHP yee benefit po , 2010 licies and proposals. EBRI Notes is a Figure 15, Likelihood of Changing Doctor If Cost Sharing 12 was Lower or Higher When Using Doctors Who Use Health Our (Percent Strongly or Somewhat Agreeing With Statement, Among Those With Usual Source of Care) Figure random ov Spending Accounts. 37, Per ersample Source: centage Extr EBRI/ of t MGA hes Consum ee two mely or er Eng gro Very agem ups. ent in H Likely to St More spec ealth Care S ifica ay urvey, 2 With lly, th 010. Curr e oversamp ent Health les Plan were: 1) If Had th those e O wit ppo h ei rtunity to ther an HRA Chan o ge, r an 1 and adults i those wit enrolle per day (or qual program. es ha n HDH ity in h tra ot d fP d her perio a choice o HDH s or tra itional rmation, part P enro covera of ddition ) he for llees al pl al ge to icipation hospital th plan, compare were less l ans. In report a Incentives and in izatio 2 w 0ie n. 10, ccess issues, e kely t llness pro I 45 d with 58 o ndivi pe report rcent g duals ra Ty hav ms, perce pe of Health of t s enroll pecially iopinions n hg ose in nt acc ed in of amo ein C ss to a M a di D b nPlan, viduals e out provider enga g t HPs re dicar hose with health 2010 e ported a chro ar in tra e no promoti d a healt it eli tional plans geme goible to n pro h nic probl nt, cost-sharing hea g m ,ram. e a lth pro a m an nd 50 ke HSA When it d those b pe lem, rcent comes with of an oversample of individuals with a CDHP or HDHP was added. The oversample included 876 individuals with a CDHP 70% indivi Calculated from Figure 1. duals 60% with traditional 46% coverage, 69 percent with an HDHP, and 74 percent with a CDHP think it is extremely or 100% EBRI directs members and other constituencies to the information they need, and undertakes new Distributio80% ns from an HRA for qualifi monthly ed me period dical eical providing cu xpenses are mrrent information on a variety ade on a tax-favored basis. Emplo of employ 47% yers ee b can a enefit topics. lso let doctor about 45% a other treatment options and costs; asked t 2005 2006 h 2007 eir doctor to 2008 2009 recommend a 2010 less costly prescription drug; partici Health pSt ation atus and Demo 100% 70% 45% in two types o grafp we hics llness ................................................................................................ programs: a health risk 2005 assessment an 2006 2007 d a2008 health 2009 promotio 2010n program that .......................... 17 included  80% 35% Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). 18% Information Technolo Checked 64% whether gy plan (HI 64% would c T) and Curr over care ent Doctor Does Not Use HIT, by Type of Health Plan, 53%* 2010 .............. 18 HSA, and 2) those with a HDHP without an account but 75%* with deductibles that are generally high en 70%*^ ough to meet the by Ty Communic pe oates f H e with y 76% alth Plan, ou so that y2005–2010 ou can really under ............................................................................................. stand what .............. 34 compare household inc those witd h a wit b H h ome of $50,000 or D 5HP 0 perce (Fig 63% ur ne t a 2m 1). ong those Th above. ese resu in traditio lts are inal n co pla ntr nast s and 52 to findper ings cent amon from 2005 g H an Dd 2 HP enrollees, althou 006, whe 82% n individgh uals thes wit e h incentives contributio to partici rela ns, p ted to although th ating in pla a 92% n we ty ey 74% pe a llnes are a n sd value program, ble to wit -based insuran h CD draw mon HP enrol ece de ly ees from the HSA were sign, more health status an lik for quali ely than fied m tra d enrolle de iti dical onal e c expenses and certa plan hara enro cteristics, choi llees to take ice of n and 1,636 indi 18% viduals resea with rch on a a HDHP, result n ongoi EBRI’s ng ba P in eg in nsion Inv sis. a 2005 total sa estme 2006 mp nt Re le 2007 port (base provides detailed fin 2008 plus oversample 2009 2010 ancial ) of 9 in 9formation on th 3 for the CDHP 53%* e universe of group and The 2006 survey found that indivi 73%duals 73% 8in 33% CDHPs and H Don't Know DHPs were less likely to c be satisfied with the quality of care very importaHDH nt that th P = High-ded eir do uctible he ctor coach t alth plan with h deduc em about tible $1,000 stayi + (individu nag he al), $2 althy b ,000+ rat (family), her th no acc an just t ount. reating their health problems. And publications 70% 61%^ 61% c 72% develo employees ped a us be an udget to m HRA toa purchase nthey age are s healt aying healt h car he e insura xpens T nrce aditional es; a directly from nd c HDHP ahecked an bCDHP pri insurer. ces before Sinc get e unuse ting cd are. fun ds are allowed to roll 60% 89% 42% 52%^ 71%^ 71% 87%* a number of c different types of benefits. 70% 2005 Traditional 2006 2007 HDHP 2008 CDHP2009 2010 2 Choice ofYes Health Pla 13 n, Premiums, and Reasons for Choosing Plan ................................................................ 65%*^ ........... 20  90% 90% CDHP = Consumer-driven h 87% ealth plan with deductible $1,000+ (individ 4% ual), $2,000+ (family), with account. qualifying threshold to make tax-preferr 69%^ ed contributio 39% ns to such an account. High deductibles were defined as 86%defined benefit, defined contribution, and 401(k) plans. EBRI Fundamentals of Employee health dif traditional premiums. More information about HRAs and HSAs fere advantage o pla nces ar n cov 60% 40% , In pr e not e emiums, plan rage were m dividuals also EBRI maintains an f t statistically sign he health ochoice, co risk re likely to may not make an HSA assessment and t ifica d analy ntribution nca h t. ave a c n be found in the zes the mo h behavior oice o h contri e health fst comp h among those bution box on pg. 39 ealth promotion pro pla if claim rehen n thsi an i with e ve databa and in Fronstin d as ngdivi ram. a CDH a dual depen Amon se Ps enrolled , satisfaction and attitudes, a of 401(k) d (2002 and 20 ent g those 63%*^ on a 44% in 63%* -not part n type C oth DHPs (Fi 0 e prog 88%* 4). r person’s ta 68%^ icipatin ram gure sg, in the 22). n tx h d e 1,914 for the HDHP group. After factor Employee- ing out o Only Fafmily the base sample—the 117 individuals with 84% a CDHP and the 278 70% 40% 62% 38% 2005 2006 2007 2008 59%* 2009 39%* 2010 receive about odn tha e-half 70% n those in of indiv tradit iduals, rega ional plans. Ho rdl 84% ess of wever, plan type, in 20 thin 07, the k it is gap in s extremely or very atisfaction important that between those their doctor in traditional use plans Figure 16, Likelihood of Choo16% sing Doctor by Their Use of Health Information Technology (HIT), by Type of Health over, employe 50% As eks are ed for gener able ic to drug ins accumulate tead of brand f name unds over drug time. Employers can allow former employees to use a 50%* ny leftover Figure 38,60% Following Treatment Regim 66% ens for Five Most 37% Chronic Diseases, 2010 ....................................................... 35 40% 57%* 60% 57%* 60%^ 82% 5 No *Differen ce between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. Works with you to find realistic changes Benefit Programs you c 59% an make to impr 38% offers a straightforward, b ove asic explanation of employee benefit programs in In 2009, th 30% 16% e survey found a 46% 46% reduction in the percentage of indivi 63%* 79% duals 63%* with traditio 56%* 63% nal covera 63%* 72% ge reporting t 51%* hat they or a individual deductibl worl es of d. Its co at least $1, mputer 00simul 0 and afamily tion analy deductibl ses on So es of cial Secu at l 29%* east $2, rity reform 000. b The and retireme final samplent income a included 993 dequa in cy Employee-Only a c Contributio The survey als 60% n Behavior a o foun 45%d tn hd A at tccount Balanc he 45% percentagees of 37% .................................................................................... individuals in a CDHP with a choice of health plan grew from ..................... 24 47 percent   health return. CDHP reasons they care us MORE E 80% e an NGAGED d acc gave IN e wer ss i W e ssues. E tha LLNESS PROGRAMS t they could make cha : CDHP enroll nges on their o ees wer we n; t more hey lacked t likely than tra ime; an ditiona d they l pla were al n enrolle reaes to dy individuals with a HDHP—there are 1,601 indivi 54%* 54%* duals in the sample 61%*^ with traditional health coverage. and those with CDHPs 75% dis 75%apyp our eare health 56%d because satisfaction in 75% creased sig 75% Traditional nificantly HDHP among CDHP those with CDHPs, and it medical It found t termi hat 80%CDHP e nology duri nrolle ng es patient are more -provi lik dely than er discussions. Only 36% traditional plan bet enro weenllees to 19 percent report an that they d 26 perc 71% ha ent t d the o hink it ption to is extre fill out mely Plan, 2010 74%.................................................................................................................... 74% 55% ........................... 18 money in 3 the HRA to continue to cover the priv quat alifie e and d m public s edicale ex ctors penses. . The EBRI Data Funds canbook on Emplo be used for out yee Benefits -of c -pocket e is a xpens statistic es and al Not sure 54%^ 52%* ab 35% 60% 49%* Adults in family mem See www.mer CDH 60% beP r de cs and HDHPs er.com are uni layed or a /press-releases/1364345 que. v wer oided gettin e significa g healt ntly less lik h care ely 57%* due to to smok thee than cost. This wer 57%*^ dec e adline ults was statisticall i35% n traditional pl y signi ans in ficant all si fo x yr both ears of 35% 72% HDHPs wit 50% h either an HSA or HRA (con41%^ sumer-driven health plans, or 50%* CDHPs) 70% Tr, aditional 70% 1,914 iHDHP n HDHP CDHP s without accounts, and Figure 39, Access Issues, by Family Type of Health Plan, 2005–2010 .................................................................................. 36 report t to 70healthy. percent hat th 60% ey ha Reas betw 49% ons for l d th een 2 e o 005 pack of partic portunity and 200 to f 9 bef ipatio ill out a ore dro n did not hp ep alth ingdiffer t rio sk assessment, an 65 by plan ty percent 51%* ipe. n 2010. d e T qual he ly d likely to ecline from report that th 70 percent to ey h 6ad 5 per- Talked to doctor about prescription options and costs68% 40% Satisfaction and Attitudes ............................................................................................................................... 50%* 50%* 46%* ...... 26  remaine or very im d unc porthanged throu ant that theirg doctor h 20 67% 09 67% referen be ac (Figu c cre work o e e 3 ssible 3). Satisfa n by emplo e-m 33% cy a tion le ee ben il. 48%* v efit pr els dogr roppe ams and d amo 48% work force-related issues. ng people in each type www. of ebri. healt org h pla n a health risk 50% 70%assessment. Specifically, 38 percent of CDHP enrollees reported that their em 45%*^ ployer 45%* offered a health risk premiums 14% for insurance, long-term care, COBRA, and retiree 2005 healt2006 h benefits. Em 2007 2008 ployers are 2009 2010 not required to make Is accessible by phone 38% 40% 6 52%* 32% 72% 44%*^ 50% 46% 64% 64% 47%* the survey: Indivi persons with a duals 70% in who have 201 nd without 0, 9 reach perce he en alth d a t of gprobl those i e 55 an ems, as well n d CDHPs, 1 are not yet as for 2 per enrolled cpe ent in HDH rsons w in Med ith Pic s, and 15 lare may mak ess than percent of those $50,000 e catch- in house up cont wit hold i ributions. h traditional ncome In (Fi2g009, ure a 1,60 In ad 1 i ditio n more n to 25% traditio being stnal ratihe fiealth d, thplans. e base sa mple was also we 46%* ighted by gender, age, education, 24%* region, income, 45%* 62% and Figure 17, Interest in Enrolling in Plan Using Select Networks Composed of Only Medical Providers With Records of cent between 2009 and 2010 was statistically sign45%* 61% ificant. The fact that choice of health plan has be 52%* en growing among access to a 30% health promotion program. HDHP enrollees were less likely to report having ac 66%* cess to a health promotion 30% 30% 30% betw 4 een 2009 and 2010. The previously observed gap 44%* in satisfaction rates for quality of care received remained assessment (Figure 50% 9), compared with 29 percent of traditional plan enrollees and 25 percent of HDHP enrollees. When 31% unused ba Health Ca re U 30% lancses availa e and Access ble to Issues workers ............................................................................................. when they leave. .......................... 30  See www.healthcaredisclosure.org/ 11 EBRI make 30% 60% s information freel 12% y available to al 12% 41% l 69% 41%* 38%*^38%* c 39). ove A co rage smoke ntinu 40% Ted alkd ed decl . Pe to doc op ine torle wa about tr in CD s not fou eatment HPs options w ne d in re and a 201 lso mor cos0. ts e likely to exercise in all years o 28% f the survey 36%* except 2010, and they $1,0 Cost- ? 0Financ 0 catch Cons ial -up co ince cious Beh nntributio tives wen re avior was no more a allowed. The factor for catch CDHP -up contribution enrollees th ian s not in for traditio dexed nal to infl plan en ation. rolle es when it came to race/ethnicity 50% to reflect the actual proportions in the population ages 21–64 with private health insurance coverage. Providing High-Quality Care Combined With Lower Cost Sharing, by Type of P 47% lan, 2010 ................................ 19 program. CDHP enrolle CDH 12%eP enro s at least llees until we 20 re more 10 may Contact EBRI likely be because than tra Publications, (2 an dition ina cr l eas plan ing 02) 659-0670; enroll perce ees to take adv ntage of fax publication the36%* Cantage of the DHP popu orders to latio health n works (202) 775-6312. risk for an 27% 60% 60% Takes responsibility for coordinating your care with other 33% betw Contribution Behavior and Ac een tradit 40% 40% ional enrollees and HDHP encount Balances rollees. asked about t 40% he availability of health promotion programs, 45 percent of CDHP enrollees an70% d 39 percent of traditional EBRI assume 26% s a public service responsibility to 34%*^ make its findings co 11%mpletely accessible at www.ebri.org 29%*^ 36% Fin Conclusion .................................................................................................................... dings from 25% this survey are compared with findings from the 2005, 2006, and 2007 EBRI/ ...................................... 30 Commonwealth Fund   30% were less lik participel atin y to be o g in welln prov bese ider ess pro s, compare specialis gts rams. Howev Subscriptions to ord tes wit ting fac h adults e ilitiese r, CDHP EBRI nroll Issue Bri ed anin d a HD e traditio fs HP enrollees were more li are included 32%*^ nal health as part of plan in EBRI some yea ke membership, or as part of ly than rs, inclu traditional ding plan 2009 a The CDHP40% an 50%d HDHP oversamples were weighted by gender, age, income and race/ethnicity, 68% using the demographic 5 20% 31%* The employer theory be withhind 500 or account more -based employees plans (a as n shown d plans with in Figu high re 20) an er deducti d thb ales is t t large em hat tploy he cost-shari ers tend to o ng structure ffer more benefit is a tool assessment Cost-Sharing Incentives and the health promotion program. 22% 22% 22% 41% 32% 25% 30%* See Appendix for more detail Orders/ on the methodology. 10% plan enrollees — so that all deci reported that their sio 23% employer ns that relate to emp offered suchl oyee ben a program. efits, wheth The differenc er m e ade in Cong between CDHP ress or bo and trad ard room itional pla s or n Among individuals with a CDHP, some receive employer contributions to the account, while 65% others do not. HRA Asked doctor to recommend less costly prescription drug 39%* Figure Distributio 18, Likelihood of Cha ns from an HSA ca nn b ging to e ma $199 annual sub Selec de att any tim Netwsork I cription e. An f C i to u ndivi rre EBR ndual t D I Notes o ne ctor ed and W not aEBR s N be o I Issue Brie t covere in Seled cfs. tby a Network, 24%*^ Individual high- de cop by Ty ducti iespe o b arle e av fhealt Pla ailan, bl h pl e an Consumerism 30% in Healt No Employ h Care er Surveys, a Contributions nd the 2008 and 2009 EBRI/MGA Consumer Engagement in Health Care 40% 10% 50% 17% 20% 20% and 2010. 23%* enrollees to choose a doctor based on his or her use of health 17% information technology (HIT 37% ). However, while CDHP profile of the Appendix—Methodology CDHP and HDHP .......................................................................................................... respondents to the omnibus survey describ 21%21% ed below. ............................. 3   Unlike satisfac that will be 30% Under motion w re like stands yiou as th ly to qual a e per nistgage i on, y of car including ndivi ey r our du e19% ce wor als in t ived, t k life, per hh s eir e onal dif hefalth car erences i e, com n overa pare ll satisfaction d with pers l ons enrolle evels by pla d n in t more ype 22%*^ foun tradit d iin o a nal ll options. 9% While pane 30% 20% 40% l Ifamilies’ ho nternet survm eys are es, are nonran based do on the highe m, studies hav st qualit e demonstrated that y, most dependa such ble informatio surveys, when c 70% n. EBRI’s Web arefully design siteed, posts Questions were asked in 2032% 08 20% about cost-sharing variations as an incentive regarding choice of provider, but 20% 2009 a enrollees was not statistically signiwith prepa ficant. However, yment for $25 each 30 percent (f of H or printed DHP enro copiellees s). Change of Address: reported the avaEBRI, 1100 13th St. ilability of a health enrollees will get employer contributions but are unable to make their 20%* own contribution. In 20%* dividuals with an HSA can 30% Traditional to with Concdra lusio 2010 .......................................................................................................................... w mn o ney from the life, and beliefs HSA (although he or she must have been covered by a high-deductibl ............................. e health plan at the 19 Surveys. Past FINANCIAL INCENTI reports used VES N O “Comp T A FACTOR, rehensivBUT HI e” as the descrip T IS: Financial tive label incent foives wer r what is no e no w more a labeled more factor 71% for CDH “Traditio P e nal nro ” h llees ealth 6 Subscriptions 20% enrollees were more l 20% ikely than traditional plan enrol 18%*lees to report 16% that they wo 18%*uld be interested in using select 20% prior ye coverage. Traditional plans include a br ars of Th 15%all resea is study the survey fin rch finding d co s ev ntinue oad range of pl idenc s, publi d e th in tat a he cations, an 201 dan types, includ ults in 0 fin CDHPs din d n gs e(Fi ws alert and H ing health ma gure 3 17%* Ds HPs 4. EBRI also exte ). Tw raditiona intenance orga ere morl eplan liknds its e el enroll Employ y than t nizations (HMOs), preferred provider erees Contr dhu ose i c wer ibutes ation and pu e n more traditional likely bli pl t c se han ans to rvice Definitions ................................................................................................................... NW, Suite 878, Washington, DC 18% , 20005-4051, (202) 659-0670; f ....................................... 39 ax number, (202 73% ) 775-6312;   obtain results 40% Dev comparabl eloped budget eto manage to random health -c digit are ex-pens dial t es elephone surveys. Tayl 17% or (2003), for example, provides the results from marked the first year that questions were asked regarding 16%* health information tec 16%*^ hnology (HIT), and these questions promotion 8% program, significantly lower than of 17% fer rates among CDHP and traditional plans enrollees. contribute th 30%eir own money to the account and may or may not also receive employer contributions. Two-thirds 20% 16% 16% There time the funds were 30% some statisticall were placed y signi in the HSA) ficant. demographic Distributions ar differ e excl ences amo uded fron m g i taxa n 25%* divi ble dua inco ls enrolle me if to to they Ac Acd c count ount in t are he used to three types of pay fo r To e plans. A fficiently label 20% 20% ichange dentify res was a ponppro dents priate giv who woeuld n that 12% 12% qua * these lify for plan the C s ar De not HP an as compreh d HDHP oversamples, th ensive as they e stu were i dy use n thde Synov past and ate’s The than 20 for tra 10 EBR 15% 15% ditiIo/MGA nal 7% 7% plan Cons enro umllees er Eng when it agement i came to n Hea partici lth Care patin Su g in rvey welln finds conti ess programs. nued slow However, growth i CDHP an n consumer b b d HDH -driP ven When offered Coac Coac a choice of health hes hes y yo ou u on on s st tay ayiing ng healthy healthy plan, t , r rather ather than than her jus jus e are many t t tr treating eating y your our reasons why an individual may choose a particular plan. When networks of role to improving Ameri high-quality doctors whe e-mc aan il: s’ finan subscriptions@ebri.o n combine cial kn d with owle lo rg dge wer cost sh 15% 15%thro Membe ugh its a rship Information: aring, w wh ard en -win it cning p ame to sw Inquiries reg ublicitchi service na g rding EBRI doctors i campaign f 13%* 66% HDHP CDHP a exhi organizations (PPOs), other managed care bit a n num d HDber o HP enrol f cost-co lees tn oscious be be extremel havi plans, and pla y or very satis ors. Specificall ns fied ywith , those in w a broad variety of cost-s ith th CD e ov HPs and HDH erall plan in all years o Pharing arra s were more f t nge he survey. I likely tha ments. The shared nn tho 2010, se in 20% 20% Figure a number 19, of s Agru eement rveys that 15% With we Statements a re conducted at th bout Proposed e same tiWays to me using th Enga e ge Co same qu nsumers estion in M naires anaging 64% both viHealth Ca a telephon re C e ao nsts, d were asked again in 2010. There was no difference by plan type when it came to changing doctors if cost sharing was Health Savings Accounts health pr ....................................................................................................... ® oblems 13% ........................... 39  (64 percent) of indivi 11%duals 11% with an employment-based CDHP (including both those c 24% overed as an 69% individual and those health plans 15% and changes to these findings. In past years, it was found that individuals enrolled in CDHPs were qualified medical expenses as defined under Internal Revenue Code (IRC) Sec. 213(d). Distributions for premiums for omnibus surv may no lo enrollees were more l nger 20% 30%e fit t y of mor hat l ikely t e abe tha l. hn Prior rese an traditional 87,00 membership and/or contributions to EBRI-ERF 0 o arch nlin e pa plan has shown nel enrol mem lees tha bers who to choose a t cost sharin 12% met 12% do the stu g has be ctor base should be directed to EBRI President/ASEC dy’s crit en d o incre n eria his or asing across t (havin her us g private insur e of he hea board in lth an th ce an e d health plans: C 5 percent hoosetoSave of the and the population co mpanio was enro n site lled in ww a C w.c DHP, hooup setfrom 4 osave.o percen rg t in 2009. Enrollment 10% in HDHPs asked a their bout t doctor he mai was not in the network, there Chec nk r ed pr eason for ice of servic enrol e before lin getting g in ca areplan, was no 51 differ percent of CDHP enrol ence by plan type. lees 29%* Similarly, reported th there was at they enrolled also support in because 6% 9% 74%* 60 traditional characteristic of this group is that they percent o cov 10%f traditional erage to say t 9% plan h enro at they 12%llees ha either were extremely d chhave no ded ecked wheth o uctible or deductibles th e 9% r very sa r the plan tisfied with t would cover car h at are below current thresholds that would e overall health pla e (53 11% percent C nD , compar cHP and H ed Dwith HP vs. CDHP enrollees were more li 10% kely than traditional plan enrollees to take advantage o 9%* f participating in a wellness online. He by Ty 10% foun pe o d th f at th Pla 12% ne us , 2010 e of ......................................................................................................... demographic weighting alone was sufficient12% to 27% bring almost all of the resu ..................... lts from the20 lower or higher when using a doctor who used or did not use HIT. About one-quarter of individuals reported that they 10% 20% 10% 5% 8% 7 CDHP with family coverage) reported that th Chairman Dallas e employer co Salisbur ntribu y at the ted to t above he a addr ccount, ess, (202) 659-0670; while 32 perce-mail: salisbur ent reported that y@ebri.org they did signific COBRA Health Reim antly m (Cons Us oo lidate bursement es re like medicd al Om ly tha terminology ni Arr n bus B those i a n when gements udget exn plaining s tra Re d ............................................................................................. iconciliation tomething ional plans to to you Act of have 19 hi 85 gh ), lon household incom g-term care ine. Howev surance, h er, i ealt nh 20 insura 10, .................. 40 wh nce ilew persons hile   age form of 21–6 hi4.) gher 10% The de follo ductiwin blesg athree nd coqu -paym estion ens were ts, and t use here d inhas been the Junea ret and uJuly Omni rn to coinsur bus ance. Surveys to i 7% dentify likely CDHP and increased fro information te m chnology 13 percent (HI iT n). 2009 to 14 percent in 2010. Overall, 12.1 million adult 52% s ages 7%21–64 with private of the lower 10%premium, while 46 percent reported that the opportunity to save money in the account for future years differing degr 7% ees for other ways patients could receive lower cost sharing, such as by actively participating in a 10% 8% 42 47 qualify for a ta perc percent am ent tra 10% x-preferred HSA contribution d ong C itional D)HP ; asked for enrollees a a generic nd 35 or percent amon dru that they ar g instead e generally ass g HDHP of a bran enroll d na ome (51 percen ees. It is ciated with HRAs. also 6% worth t CDHP, noting t 50 percent HDH hat the overal P vs l . program, either the health risk assessment or the health promotion program. Three-quarters of CDHP enrol 7% 10 a lees online survey 10% 20%close to the replies from the parallel telephone survey. He also 24% found that in some cases propensity would change doctors to one who used HIT if cost shari 9%* ng was lower, and about one-quart 53% er reported that they would Traditional 8% not receive employer contributions, and 4 percent did not know if the employer contributed (Figure 25). in CDHPs were more likely Checked t quality han those rating of doc wi tor th traditio /hospital nal coverage to have househo 22% ld income of $50,000 -$99,999, receivin EBRI is sup g une 4%mployment ported b compensation, y organizations from all industries and sectors that appreciate the value of and insurance while eligible for Medicare 14% 7% other than for M 4% edigap, 4% are also tax- HDHP respondents: 5%* 13% 56% Figure insurance, 20, Selected Demo representin 5% g 9.5 graphics, percent of tha by Type of Health t market, wer Plan, 2005–2010 e either in a CD........................................................... HP or were in an HDHP that was eligible......... for an 21 Refer was a ma program ences in r ............................................................................................................................... e to m ason for aintain enroll or im ing prove hea in that pla lth, n (Fi by follo gure 2win 3).g Among i treatment re ndividuals wit gimens, and by h traditional h using sci ealth entif c ........................... 41 o icall verage, y proven 42 percent   22% 3% Editorial Bo 0% ard: Dallas L. Salisbury, publisher; Stephen Blakely, editor 11% 11% . Any views expressed in this publication and those of the author 6%* s should satisfaction l 44 percent tra evels among C ditional); talke Dd HP enrollees increased to their doctor about other from 37 treatment percent 11% 11% opt to 47 percent ions and costs (36 between perc 2006 and 2007 an ent HDHP vs. 31 d wer percent e participated in 0% the health risk assessment, compared with 60 percent of traditional plan enrollees (Figure b 10). Similarly, weighting 10% (me 5% 0% 0% aning the propensity for a certain type of person to be online) reduced the remaining gaps, but in other HEALT change Hdoctor STAT 0% US s to one IS BET who TER used HI : Adults in T i CD f noHPs wer t doing so e9% sign incr ificantly eased t less li heir co kely to smoke st sharing (Fig than ure 15 were ). adu HDHP lts in traditional a Is accessible by email 3% c 7 a b 26% c signific free.unbiased, reliable information on emplo This ant mea dif 10%fe nrences s that wer distributions used to e not fou aand at $100, pay M 00e 0 or m dicare y7% ee b ore. Howev Part A or enefits. B, er, Medicar CDHP Visit an www.e e A d HD dvan bHP enrol ri.o tage rgplan /about/join/ lees premiums, and th c were for more. more likely than e not be ascribed to the officers, trustees, members, or other sponsors of the E b b mployee Benefit Research Institute, the EBRI Educ c ation and HSA but had not opened the Traditional account. HDHPb CDHP cited the See Fronstin (2007) and good network of http providers an ://ehbs.kff.org/pdf/2010/8085 d 36 percent report .pdf the 11% low out-of-pocket costs as the main reasons for enrolling effective c 0% 5% If employ are. CDHP 2%* er offer enrol ed If r le equir es wer ed to e mor If employ e likely tha er offered If employ n trad er itional offered plan If employ enrollees to er If employ support t er made h If employ e use erof lo reducwer cost ed Traditional Traditional Traditional HDHP HDHP HDHP CDHP CDHP CDHP 5% 52 perc traditional Endnotes Summary ent in 200 ...................................................................................................................... ); asked th of Findings 9, whil eir doct e the or to recomm overall satisfend a l action e rates ss cost foly pres r traditio cri19%* nal e ption dr nrollees wer ug (39 per e unchan cent HDH ...................................... 41 geP vs d. B.e 32 twee 4% p c ercent n 2009 and   52 percent of CDHP enrollees participated in a health promotion program, compared with 41 percent of tradit 3% ional plan cases it did no Among the 64 Used perc t reduce t online ent cost with trh ace k r ing tool an em emainin provployer ided by g gaps health co . Perha ntributio plan ps th n, 1 e 3mo pe10% st rcent striking dif received less ference in demographics betwee than $500, 28 percent received between n telephone 2% 0% plans, and were less likely to be obese. 2% CDHP Figure Resear 21, ch Fund, Percentag or ca their sh in ece of staffs. nti In ve Nothin dividuals participate to g her Cover eenr in is to be co oll ed by Emp time off nstrued as an attem loyment-Bas discounted pt to aid or ed H inc e hi ralth eas nder ed pr Ben the adoption emium efits With additional of a Choic ny pending le e acnd ontr gislat iNo C bution to ion, hoice regulation, 22% 1% 1% traditional plan enrollees to be highly educated, which may also explain 20%* the differences in behaviors and attitudes 1% employee sharCan e of send lab test the premi results to um for Allows emp patients loyment-based to set up Allows patients retiree health to request benefits ar Will answer e a patient's llowed on Is able to a tax-free use real-time, basis. in the sharing to engage plan. 0% patients. Sour Sourcce: e: EBRI/Commonwe EBRI/Commonweal altth h F Fund Cons und Consumer umeris ism m in Health in Health Car Care e Su Surrvvey ey, 2005- , 2005-2007;EBRI/MG 2007; EBRI/MG AA Cons Cons umer umer Engagement Engagement in Health in Health Car Care e Unlike the gen 0% eral Exquestion tremely Likely on HIT in prefered Ver an health y d co Likelyst sharing as i Somewhat Lik nce ely pr ntives to emiumNot Ver switch to for y Lik nonpar ely tici a pants doc Not at All t cor who ontr Lik ibution to ely uses HIT, w Don't Know HRA/HSh Aen more 2010, satisfact traditional or interpretative ); developed a 0% Sour ion with t Sour ce: ruEBRI/Commonwe cle, or as e: EBRI/Commonwe h legal, e o budget verall h acco alth to ma al F unting, tund Cons h Fe und Cons alth na actuarial, o umer plan ge umer ishealth m is dropped a in Health m r other such prof in Health car Car ee Su Car ex m eong rpe Sur vey essional advice. nses , v2005- ey peo , 2005- 2007; EBRI/MG (25 ple i 2007; perc n eac EBRI/MG ent h A type o Cons CDHP A Cons umer umer vs. 16 f Engagement healt Engagement h percen plan. in Health Car in Health t traditio e nal); checked This survey enrollees. finds that patients by in 20 e-mail 10, 5 percent appointments online of the popul and receive referrals ation was enrol online led in questions via a CDHP, u e-mail p from virtual 4 perc visits to offer "fac ent in 2009, a e-to- nd and o 8 $500–nlin $99e sur 9, 25 v eys was th percent rec e eunder ived bet -rew prese een $1,0 ntation o 00–$1, f min 499, orities in 7 percent onli n receive e sampl d betw es. een $1,500–$1,999, and 18 percent 0% of Health Plan, by Type of Health Plan, 2010 .................................................................................. bc ........... 23 Survey, 2008-2010. a The The specific q 2010 EBR 0% SurI vu/MGA ey estions were as follows: Doe , 2008- Cons 2010. umer Eng plan agement i s your em n Health ployer offer an Care Survey s y of th uggests that C e following w DHP eHRA llnenrollees are somewha e/HS ss programs? A t more between the groups Les . T s here Than O were ne Year few differences 1–2 amo Years 0% ng CDHP, 20% HDHP, 3–4 and traditiona Year 40% s 60% l enroll5 ees Year 80% rela s or Mor ted to e 100% gender, age, Surv Car ey, 2008- e Survey 2010. , 2008-2010. face' consulatations Health Risk Assessment 0%* 10%* 20%* 30% Health Pr * omotion 40%* Program 50%* 60%* Traditional HDHP CDHP INCOME NO L 0% a ONGER HIGHER; EDUCATION DIFFERENCES REMAIN: While in the past, adults in CDHPs were a Less than $200 $200–$499 $500–$749 $750–$999 $1,000–$1,499 $1,500–$1,999 $2,000 or More Don't Know specific the price of a questi aTraditio service befor ons wer a nal = e He aske alth e plan getti d it  with was  ng care (29 no defoun ductible d that C  or <$1,000 percD ent H  (indiv HP an idual), DHP vs d HDHP  <$20,00 . 24   e (family). perc nroll  ees w ent tra ere ditiona more l) like ; anld y tha used a n trn aditional online cost-t plan racking Traditional = Health plan with no deductible or <$1,000 (individual), <$20,00 (family).  3 p receive ercent d $2,0 in 200 or 008; an more d e (Fi nrog llment ure 26in H ). Em DHployer co Ps increase ntrib d fu rti om 13 ons vary, h percen owever, t in 2009 by to 1 whether 4 percent an in in di 2 vidual 010 (Fi has em gure 2 ployee- ). The Traditio Traditio nal Nothing  =nal  He  =alt  He halt  plan h plan Les  with s  with T  no han $500  de  noduct  deduct ible ior ble  $500–$999 <$1,000  or <$1,000  (indiv  (indiv idual), idual), $1,000–$1,499  <$20,00  <$20,00  (family).  (family).  $1,500–$1,999   $2,000 or More Don't Know Distributions for nonqualified medical expenses are subject to regular income tax as well as a 10 percent penalty, which cost conscious in their decision-making than those in traditional plans. CDHP enrollees were more likely than traditional and r Among th ace. e po bb   Sour pulation ce: Nothing EBRI/MG with t A Cons Lesraditiona s T umer han Engagement $200–$499 l covein Health rage $500–$999 and a Care Surch veyoice $1,000–$1,499 , 2010.of plan, $1,500–$1,999 38 percent $2,000–$2,999 were offered a $3,000 or Mor CDHP or HDH e Don't Know P, and ? In 2010 Sour Sour , a Sour c cd e: e: ult cEBRI/MG EBRI/MG e: s in C EBRI/MG A AD Cons Cons AHPs w Cons umer umer umer e Engagement Engagement re significa Engagement in Health in Health in Health ntlyCar less like Car Car e Sur e Sur e Sur v vey ey v, 2010. , 2010. ey ly to s , 2010.moke than were adults in traditional plans, and were less Sour bHD  HD Source: EBRI/MGA HP bHP c   e:   ==EBRI/MG   High High--de deduct duct A Cons iible Consumer ble umer  he healt alt h Engagement h  plan Engagement plan  with with  de de in Health duct duct in Health Care Survey, iible ble  $1,000+ Car $1,000+ e Sur  (indiv  (indiv vey, 2010. idual), idual), 2010.   $2,000+ $2,000+ (family),  (family), no  no  account. account.   Differenc EBRI Issu es in Source: EBRI/Commonwealth e Brief out-of is re-pocket gistered in the U. costs may explain a Fund S.Consum Patent and T erism in radem Health Care Survey, sign ark ifica Office. nt Iportio S 2005 SN: 0887 –2007; n of t ?EBRI/MGA Consumer 13h 7X/90 e difference 0887 ?13Engagement 7X/90 $ . in overall 50+. in Health satisfaction rates 50 Care The EBRI/MGA Consumer HDHP HD  =HP  High  = High -deduct -de Engagement duct ible ihe blealt  he halt  plan h plan  with in  with  de Health Ca duct  deduct ible i$1,000+ ble $1,000+ re  S (indiv u rvey (indiv idual), idual), asked r  $2,000+  $2,000+  (family), espondents th  (family),  no account.  no account.   eir reasons for   not participating in significantly more likely than those with traditional health coverage to have a high household income, most of the F enrolle igure es 22 to c , Pe a arce hoos ntage e a docto of Individ r basu eals d on Cove his or her use of red by Employme HIT. CDH nt-Based P and HDHP en Health Beneroll fits ees were foun With a Choice d to of Healt be more l h Plan ikely , tool provided a by the a health plan (20 percent CDHP vs. 11 percent traditional) (Figure 6). 5 percent of t a c  h aTraditio e popu nal = lation  Health  plan with $200  with a CDH  no deduct P r ible eprese  or <$1,000 nts 5.7  (individual), million  <$20,00 ad  (family). ults ages   21–64 with private insurance, while the only or family coverage. c Traditio Traditio Traditio nal nalnal   ==  He He  = He alt alt Indi hh alt   plan plan h plan viduals with   with with  with   no no   no  de de duct duct deduct ii ble ble eible m   or orployee    <$1,000 or <$1,000  <$1,000   (indiv (indiv -only  (indiv idual), idual), idual), coverage are   <$20,00 <$20,00  <$20,00   (family). (fam  (family). ily).most likely to      get an employer contribution ? Health risk ass c CDHP Traditio Traditional c   = Co nal essment, where you answer nsum  =  He = Health e alt r-hdriv  plan  plan en  with he  with alt  no h  no plan  de  deductible duct  with ible  de  or duct  or  <$1,000 a  <$1,000 ible questionnaire  $1,000+  (indiv  (individual), idual),  (indiv idual), <$20,00  <$20,00 and then a me  $2,000+  (family).  (family).  (family),      with dical prof  account.essional examines your health history is waived ifSurvey, 2008 th CDHP Sour e ow c  = e:  Co ner o EBRI/Commonwe nsum –2010. efr t -driv he HSA en he altalt h F hdies,  und Cons plan with be umer  de comes disable duct ism ible in Health  $1,000+ Car  (indiv e Sur d, or idual), veyis eli , 2005  $2,000+ g –2007; ib  (family), le for M EBRI/MG  with e Adic  account. Cons are. umerIn 2 Engagement 011, th in Health e penalty Care for CDHP CDHP  = Co  =nsum  Consum er-driv er-driv en he enalt  he halt  plan h plan  with  with  deduct  deduct ible i$1,000+ ble $1,000+  (indiv  (indiv idual), idual),  $2,000+  $2,000+  (family),  (family),  with  with  account.  account. plan and HDHP enrollees to have reported that they made use of available information. CDHP and HDHP enrollees were 33 perc likely to ent were bbe   ob not ese. offered these plans, but 29 percent did not know if they were offered them (Figure 24). Among b  b  Sour bHD   HP ce:  = EBRI/MG High-deduct A Cons ible umer healt h Engagement  plan with dein Health ductible $1,000+ Care Sur  (indiv vey th, 2010. idual), $2,000+ (family), no account.  between tradit a b HD b ional HP = High plan, -deduct HD ibleHP, an  health plan d CDH  with de Pduct enroll ible $1,000+ ees. I  (indiv n 201 idual), 0,  $2,000+ 41 perc  (fam ent of ily), no account. traditio   nal plan participants were income their employe differ * Differenc * Differenc HD ern ’s we HD HP ces w HP  = High  e = e llness  between High between e -de re -duct de not duct pro HDHP/CDHP iHDHP/CDHP ble prese ible g  he ram. Sl  alt hehalt  plan n h and t i plan and  ight with nTraditional  Traditional 2 with  de 0 ly 10. Ho  duct de more than duct ible is is s i s ble  $1,000+ ttatis wever, atis  $1,000+ tic tically ally   6 (indiv s s  0 (indiv iCDHP a gnific ignific perce idual), idual), ant ant  at the $2,000+ at p nn  $2,000+ t res d HD =p 0.05 or =  (family), p 0.05 or  (family), HP enrol on better de  better nod that  . no account.  .account. lees the   were   y di more d not part likely than icipate tra becaus ditional e they by Ty Traditional HD Sour pe o HDHP HP cSour  e: =  fHigh = EBRI/MG H =  High cHealth plan with e: e -de EBRI/MG alth Plan, -deductible duct A Cons ible A  he umer Cons  health alt no 2005–2010 h umer deductible  Engagement plan  plan  with Engagement  with  de or <$1,000 (individual),  deductible duct in Health ............................................................................................. ible in Health  $1,000+  Car $1,000+ e Sur Car  (indiv  e Sur v(individual), ey <$20,00 , 2010. idual), vey, 2010.  $2,000+ (family).  $2,000+  (family),  (family),  no  no  account.  account.     .............. 23 than tradition * Differenc Sur al pl * Differenc veyan , 2008 e between enroll – e 2010. between e HDHP/CDHP es to switc HDHP/CDHP and h and Traditional doctors to one Traditional is stis atis 1100 13 sttic atis ally tic wh a slly ignific St o signific reet u ant se ant at p d NW · Suite 878 e at p =- 0.05 or ma = 0.05 or il to better better d. e li.ve r lab tests, allowed the individual to a 14 betw perc een ent $500 wit c –$7 h a H 50, D wh HP r ile epr those wit esents 1h 7.2 m family covera illion peop ge le.ar Among th e most likely t e 17.2 mill o get an ion i empl ndividuals oyer contri with an buti HDHP, 3 on of at l7e ast perc ent to identify any c  CDHP =co Cons nditio umer-driv ns yo en u may ha health plan with deduc ve or that you might be at tible $1,000+ (individual), $2,000+ risk for de (family), with veloping. account. nonqualified distributions c  Sour CDHP c  ce:  = EBRI/MG ConsumeA rwil - driv Cons l incr en umer  healt e Engagement ase to h plan with 2  de 0 in Health percent. ductibleCar  $1,000+ e Sur  v(indiv ey, 2010. idual), $2,000+ (family), with account. b c ^  CDHP Es ac   timate  a= Coisnsum statis er tic -driv allye differ n healt ent h frplan om the pr  with de iorduct year ible shown at the p  $1,000+ (indiv =idual), 0.05 or  $2,000+ better.  (family), with account. also more likely to try to HDHP ^ CDHP Es a CDHP timate =  =High-deductible  Co  =is  nsum Co stnsum atisetic rfind informat -edriv ally r-driv ediffer health plan n ehe n alt ent hehalt fr  plan om the pr h with deductible plan  iwith on o  with  de iorn  duct de y their ear duct ible $1, shown at the p ible  000+ (individual), $1,000+ doctor  $1,000+  (indiv  ’s cost and qu (indiv = idual), 0.05 or idual), $2,000+  $2,000+ better  $2,000+ (family), no .  (family), a  (family), lity from  account. with  with  account.   sourc account.es other than the health plan. CDHP Health r CDHP CDHP  =CDHP =    Co ==  eimbur Co Consumer nsum nsum Cons e sement re -driv r- -driv driven umer-driv en ar e he n rangement.   he health altalt en h h plan health   plan plan  with   with with plan  de   de deductible duct with duct ideduc ble ible  $1,000+   $1,000+ $1,000+ tible $1,000+  (indiv   (indiv (individual), idual), (indiv idual),  $2,000+ idual),   $2,000+ $2,000+ $2,000+  (family),   (family), (family), (family  with   with with  ), account.   account. with account. account. ^ Es^ timate Estimate is stis atis sttic atis ally tic ally differ differ ent ent from the pr from the pr ior yior ear y ear shown at the p shown at the p = 0.05 or = 0.05 or better better . . Washington, DC 20005 extremely or v a ery satisfied with out-of-pocket costs (for health care services other than for prescription drugs), while * Difference between employee-only coverage and family coverage is statistically significant at the p = 0.05 or better. plan enrollees c # * Differenc Differ CDHP to be enc  = e between hi Co e between nsum ghly er e -2005 driv HDHP/CDHP ducate en and  healt 2010 is d h . plan and s twith Traditional atistic  de ally duct sis ignific ible statis  $1,000+ ant ticat ally p  (indiv s =ignific 0.05 or idual), ant better at p  $2,000+ = . 0.05 or  (family), better  with .  account. schedule appo # * Differenc b Differ intments on ence e between between lin HDHP/CDHP 2005 e, allo and 2010 is wed and s Traditional tpati atisticents to r ally s isignific statis ant tic equ aat llythe est an signific p = 0.05 or ant d rec at p better =e 0.05 or ive . r better eferrals . online, answered patient questions via CDHP * Differenc * Differenc = Consumer-dr e between e between HDHP/CDHP iven HDHP/CDHP health plan with and and Traditional deductible Traditional is s $1, is tatis s000+ (individual), tatis tica tic llya lly signific signific ant ant $2,000+ at p at p = 0.05 or =(f0.05 or amily), with better better . account. (or 6.3 million * Differenc # * * Differ ) Health s Differ Difference between HDHP/CDHP re # Differ enc porte enc e av e between enc e between between ings e between d t ach cHDHP/CDHP ount. a 2005 employ t they 2005 and ee- and 2010 is wer only and 2010 is and ce ov Traditional s e tTraditional atis er ls age and family ig ttic atis ibl ally tic e s is ally s iis for an gnific t s atis statistically significant at ignific ant tic cov a H lly ant at er p age sSA but iat gnific = p 0.05 or is = s ant 0.05 or tatis did not at p better tically = p better 0.05 or = . s0.05 or ignific . have better ant better. at the p such a . = 0.05 or n account. better. Thus, overall, © 2010, Employee Benefit Research Institute ?Education and Research Fund. All rights reserved. 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2010 • No. 352 2010 • No. 352 352 52 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 search Fund © 2010 Employee Benefit Research Institute 13 36 19 25 34 32 27 18 21 23 15 29 28 33 35 22 16 12 6 9 8 37 42 5 40 20 17 14 38 30 26 41 31 10 24 39 11 2 3 7 4 Figure 39 Figure 7 Access Issues, by Type of Health Plan, 2005–2010 Trends in Cost-Conscious Decision Making, by Type of Health Plan, 2005–2010 a b c Traditional HDHP CDHP Base: Adults 21–64 who received some health care in last 12 months 2005 2006 2007 2008 2009 2010 2005 2006 2007 2008 2009 2010 2005 2006 2007 2008 2009 2010 a b c Total sample 1,358 1,506 1,918 1,714 1,651 1,601 487 930 1,404 1,634 1,603 1,914 186 722 895 1,184 972 993 Traditional HDHP CDHP Total 2005 2006 2007 2008 2009 2010 2005 2006 2007 2008 2009 2010 2005 2006 2007 2008 2009 2010 Not filled a prescription due to cost (you or family members) 16% 16% 17% 15% 15% 14% 26%* 21%* 21%* 21%* 18%*^ 19%* 21% 23%* 19%^ 17% 21%* 19% Total Sample 953 1,363 1,794 1, 1,548 1,651 Figure 20 417 601 8021,2841,4841,6931,914163652805 972 1,077 993 Skipped doses to make medication last longer (of those who were given a prescription) (you or family members) Selected Demographics, by Type of Health Plan, 2005–2010 15 16 16 15 17 17 25* 22* 22* 22* 22* 19^ 20 23* 17^ 16 23*^ 19 Checked whether health plan would cover care 51% 58% 50%^ 55%^ 50%^ 47%^ 61% 62% 61%* 61% 56%* 53%*^ 60%* 62% 60%* 63%* 61%* 53%*^ Not filled a prescription due to cost or skipped doses to make a b c Asked for generic drug instead of brand name drug Traditional n/a 48 46 50^ 46^ 44 n/a HDHP 60* 58* 58* 52*^ 50* n/a 54 CDHP 54* 58* 56* 51*^ medication last longer 22 22 23 (Fig. 20 cont'd from previous page) 21 22 23 32 29* 29* 31* 28* 28* 30 31* 24^ 23 31*^ 28 Talked to doctor about prescription o2005 ptions and c 2006 osts 2007 n/a 2008 n/a n/ 2009 a n/ 2010 a 35 2005 35 2006 n/ 2007 a n/a2008n/a 2009 n/a 2010 42 2005 40 n/ 2006 a n/a2007n/a 2008 n/a 2009 44 2010 38 Delayed or avoided getting health care due to cost (you or family Total sample 1,358 1,506 1,918 1,714 a 1,651 1,601 487 930 1,404 1,634 b 1,603 1,914 186 722 895 1,184 c 972 993 Talked tmembers) o doctor about treatment options and costs 42 44 17 19 44 16^ 45 22^ 33^15^ 31 12^ 31* 56* 33* 44^ 32* 49*^ 30*49 28*37^ 26* 36*# 37* 58*38* 4629*^ ^ 47 26 46 22* 40* 23*# 33^# Traditional HDHP CDHP GenderAny of the above 29 30 28 33^ 29^ 28 44 44* 43* 43* 41* 39* 48 49* 38*^ 35 41* 38* Asked doctor to recommend less costly prescription 2005 2006 2007 2008 2009 2010 2005 2006 2007 2008 2009 2010 2005 2006 2007 2008 2009 2010 Male Health Problem** 49% 49% 50% 48% 50% 50% 53% 49% 51% 50% 48% 46% 57% 50% 57%* 54%* 52% 44%* drug 27 31 30 36^ 34 32 46* 41* 43* 41 39* 39* 45* 39* 38* 36 39* 37 Self-Rated Health Status Not filled a prescription due to cost 21 18 21 19 19 16 30* 25* 24 25* 23 23* 26 25* 26 23 26* 24 Female 51 51 50 52 50 50 47 51 49 50 52 54 43 50 43* 46 48 56* Checked price of service before getting care 24 20 21 23^ 25 24 35* 23^ 27*^ 23^ 29^ 29* 29 26* 27* 25 35*^ 27^ Excellent/very good 42 54 49 56 59 59 50 53 54* 54 59 58 58* 60* 65* 66* 64 67* Skipped doses to make medication last longer (of those who 78 67 78 76 64* 62* 64* 68 70* 71 70* 67 Married 60 74 61 55* 59 61* Checked quality rating of doctor/hospital 18 21 20 25^ 24 24 22 18 19 22 22 22 18 19 18 23^ 27* 22^ Good 45 35 38 34 32 34 36 34 35 34 30 32 34 33 29* 30 27 28* were given a prescription) 21 21 23 21 21 22 32* 28* 28 30* 30* 25^ 30 29* 24 22 32*^ 26 47 42 44 40 37* 37 39* 40 45 46 49 47* Has children 34 42 33 35* 40 44 Developed budget to manage health care expenses n/a n/a n/a n/a 15 16 n/a n/a n/a n/a 18 17 n/a n/a n/a n/a 32 25*^ Fair/p Not filled a prescription due to cost or skipped doses to make oor 13 12 13 10 9 7 13 13 10 12 11 10 9 7* 6* 5* 8 5 Age medication last longer Used onl At least one chronic health ine cost tracking tool offered by health plan n/a 29 8 27 8 29 12^ 28 12 29 11 28 40 n/a 35* 6 359^ 38*10 36*9* 35* 10 39 n/a38* 17*34 20*^ 32 20* 40* 24* 36 20*^ 21–34 27 33 34 33 28 31 18* 24* 21* 20* 25 21* 20* 24* 20* 23* 28 20* Delayed or avoided getting health care due to cost 20 23 18^ 23^ 17^ 16 31* 37* 35 34* 34* 32* 44* 42* 32^ 32 29* 28* Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005–2007; EBRI/MGA Consumer Engagement in Health Care Survey, 2008–2010. condition** 54 49 49 52 52 50 56 50 53* 56 54 52 48 43* 45 45* 46* 45 a 35–44 26 23 22 23 23 23 25 25 24 24 24 27* 31 32* 31 30 28 36* Any of the above 35 34 33 37 35 34 48 50* 49 49* 49* 46* 58 55* 46^ 44 49* 48* Traditional = Health plan with no deductible or <$1,000 (individual), <$20,00 (family). Health problem*** 57 51 53 54 54 51 57 53 55 57 57 54 49 44* 46* 45* 49* 46 b 45–54 29 26 27 26 28 27 34 29 30 29 27 28 34 28 30 28 27 27 No Health Problem** HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. Obese 36 30 27 26 31 29 33 28 30 29 28 27 26* 30 25 23 23* 22* c Not filled a prescription due to cost 11 13 12 9^ 9 12 48 17 17 16* 11^ 15^ 15 22* 13^ 12 15* 14 55–64 17 18 18 19 21 19 24 22 25* 26* 25 24 15 16 19 19 16* 16 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Smokes cigarettes 23 24 24 20 18 15 14* 18* 14* 15* 13* 12 14* 14* 15* 13* 13* 9* Skipped doses to make medication last longer (of those who Race/Ethnicity * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. No regular exercise 24 25 25 25 21 23 15* 25 20* 21 19 19 16* 19* 17* 17* 13* 20 were given a prescription) 8 11 8^ 7 12^ 11 15 15 13 12* 12 11 10 17 11^ 10 14 13 White, non-Hispanic 71 71 71 72 70 70 94* 83* 78* 77 72 72 93* 81 75 76 72 78 ^ Difference from prior year shown is statistically significant at p = 0.05 or better. Firm Size (base: employed full- or part-time) Not filled a prescription due to cost or skipped doses to make # Difference between 2005 and 2010 is statistically significant at the p Minority 28 29 29 = 0.05 or better. 28 30 30 6* 17* 22* 24 27 28 7* 19 25 24 28 22 Self-employed with no medication last longer 14 18 16 13^ 14 18^ 22 22 21 21* 15 20 20 25* 16^ 16 24* 21 Household Income Delayed or avoided getting health care due to cost 13 16 14 21^ 12^ 9^ 31* 28* 27 26 20* 19* 31* 35* 26^ 22 15 19* employees 243233 9* 9* 9* 7* 7* 5* 8* 5 6* 7* 55 Less than $30,000 15 12 15 14 11 14 11 17* 12* 9* 10 4* 11 13 6* 4* 3* 3* Any of the above 20 25 23 29^ 21^ 22 39 38* 37 35 31* 32* 39 44* 32^ 29 32* 30 2–49 15 19 19 16 15 16 31* 32* 27* 26* 25* 26 39* 32* 28* 25* 21* 23 $30,000–$49,999 19 20 18 19 17 17 19 30* 18 14* 16 14 22 24 13 10* 10* 11 Less Than $50,000 Yearly Household Income 50–199 8 10 11 12 11 8 9 14 14 13 15* 13* 8 12 11 13 12 12 $50,000–$99,999 Not filled a prescription due to cost 34 38 36 36 24 20 38 27^ 37 20^ 36 20 35 18 2838 25 4027 43* 26 23 47* 21 33 24 43 23 27 41 19^40 25 45*17^ 54* 200–499 9898 10 8 6877 7* 8 5* 10 87 7* 7 Skipped doses to make medication last longer (of those who $100,000–$149,999 14 14 14 14 17 15 11 Fig5* ure 8 14 19* 16 19* 13 7*^ 20* 25* 24* 14 500 or more 54 45 43 50 48 52 33* 29* 36 38* 37* 41* 36* 31* 40 42 48 49 were given a prescription) 21 21 25 21 25 22 31 23 28 27 29 25 30 26 23 20 29 18^ $150,000 or more 7779 10 10 4 3* 9 9* 8 7* 9* 4*^ 11* 15* 10 11 Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005-2007; EBRI/MGA Consumer Engagement in Health Care Survey, 2008-2010. Not filled a prescription due to cost or skipped doses to make Availability and Use of Quality and Cost Information Provided by Education a Traditional = Health plan with no deductible or <$1,000 (individual), <$20,00 (family). medication last longer 31 29 33 28 29 30 38 31 36 35 33 31 36 33 32 28 35 28 Health Plan and Effort to Find Information From Other Sources, 2010 High school graduate or less 32 38 42 33 35 38 14* 17* 14* 13* 14* 10* 6* 11* 11* 10* 8* 10* b Delayed or avoided getting health care due to cost 24 29 26 35^ 18^ 18 41 36 40 37 39* 33*^ 49* 40 34 33 38* 30 HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. a b c c Some college, trade or Any of the above 39 42 41 47^ 36^ 38 53 48 53 51 50* 36 56 53 48 45 50* 44 Traditional HDHP CDHP CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. $50,000 or More Yearly Household Income business school 31 Heal 29 th plan pr 29ovides31 informat31 ion on qua 28lity of c36 are prov36* ided by do 30ctors 28 45%26 26 28%* 28 34% 33** 24 22* 24* 25 * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. Not filled a prescription due to cost 12 13 12 12 13 13 24* 19* 19 19* 17* 19* 19 23* 16^ 16 20* 19* Health plan provides information on cost of care provided by doctors 41 24* 30* ** Arthritis; asthma, emphysema or lung disease; cancer; depression; diabetes; heart attack or other heart disease; high choles College graduate or some terol; or hypertension, high blood pressure or stroke. Skipped doses to make medication last longer (of those who Of those whose plans provide info on quality, how many tried to use it *** Health problem defined as fair or poor health or one of eight chronic health conditions. graduate work 24 22 20 24 23 22 34 35* 40* 42* 42* 45* 46* 41* 41* 44* 46* 44* were given a prescription) 13 14 13 12 15^ 14 23* 20* 19 21* 21* 17 16 21* 16^ 15 22*^ 20* for doctors 45 49 49 Graduate degree Not filled a prescription due to cost or skipped doses to make 13 11 9 12 11 10 16 12 17* 17* 18* 18* 20* 15 24* 24* 21* 21* Of those whose plans provide info on cost, how many tried to use it for medication last longer 18 19 18 17 21^ 20 30 27* 27 28* 27* 27* 28 29* 22^ 22 31*^ 29* doctors 40 39 48 Delayed or avoided getting health care due to cost 13 14 12^ 16^ 14 10^ 28* 30* 29 28* 25* 24* 31* 37* 29^ 25* 20* 23* (cont'd) Any of the above Tried to find informatio 24 n from 25 sourc23 es oth 26^ er than 27 health 24^ plan on 40 cost41* 40 40* 38* 38* 45 47* 36^ 33 40* 38* Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005-2007; EBRI/MGA Consumer Engagement in Health Care Survey and quality of care provided by doctors 20 , 2008-2010. 24* 24* a Traditional = health plan with no deductible or <$1,000 (individual), <$2,000 (family). So urce: EB RI/M GA Co nsumer Engagement in Health Care Survey, 201 0. b HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. a Traditional = Health plan with no deductible or <$1,000 (individual), <$20,00 (family). c CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. b 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 = Co nsumer-driven health plan with deductible $ 1 ,000+ (individual), $2,000+ (family), with account. ** Health problem defined as fair or poor health or one of eight chronic health conditions. * Difference between HDHP /CDHP and Traditio nal is statistically significant at p = 0.05 o r better. ^ Estimate is statistically different from the prior year shown at the p = 0.05 or better. # Difference between 2005 and 2010 is statistically significant at the p = 0.05 or better.

Volume 352

Pages 44

EBRI Issue Brief

Paul Fronstin

Health