Summary
• Third annual survey—This Issue Brief presents findings from the 2007 EBRI/Commonwealth Fund Consumerism in Health Care Survey. The online survey of 4,217 privately insured adults ages 21–64 was conducted to provide nationally representative data regarding the growth of account-based health plans and high-deductible health plans (HDHPs), and their impact on the behavior and attitudes of health care consumers.
• Enrollment remains low—In 2007, 2 percent of the population was enrolled in a consumer-driven health plan (CDHP), up from 1 percent in 2006 and 2005. Enrollment in HDHPs increased from 9 percent in 2005 to 11 percent. The 2 percent of the population with a CDHP represents 2.3 million adults ages 21–64 with private insurance, while the 11 percent with a HDHP represents 12.5 million people. Among the 12.5 million individuals with an HDHP, 42 percent or 5.2 million reported that they were eligible for a health savings account (HSA) but did not have such an account. Thus, overall, 7.5 million adults ages 21–64 with private insurance, representing 6.6 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.
• Income is higher—Over 2005–2007, adults enrolled in CDHPs became increasingly more likely to earn higher incomes. In 2007, 31 percent were in households with incomes of $100,000 or more, up from 22 percent in 2005. Just 19 percent of adults with CDHPs were in households with incomes under $50,000, down from 33 percent in 2005. Among HDHP enrollees, 23 percent were in higher income households in 2007, up from 15 percent in 2005. In contrast, there was little change in the income distribution of people enrolled in more comprehensive plans.
• Health status is better—Adults enrolled in CDHPs are in better health, are less likely to have chronic health conditions or to smoke, and are more likely to exercise than are people in more comprehensive health plans.
• No impact on the uninsured—As in 2006, the survey finds that adults in CDHPs are no more likely to have been uninsured prior to enrolling in their plans than are those in more comprehensive plans. Seven percent of CDHP enrollees were uninsured prior to being covered by their current plan, compared with 15 percent among HDHP enrollees and 28 percent among individuals with comprehensive coverage.
• Lower satisfaction—As in 2005 and 2006, individuals in CDHPs and HDHPs continue to be less satisfied with various aspects of their health plan than individuals in more comprehensive plans. However, individuals in CDHPs were somewhat more satisfied with their plans in 2007 than they were in 2006, and there was a significant increase in the share of CDHP enrollees who said that they would recommend their plan to a friend or co-worker and stay in their plan if they had the opportunity to change.
• More missed care—Individuals in CDHPs and HDHPs reported using health services at rates similar to those in comprehensive plans, and there were no reported differences in the use of preventive screens or tests. However, as in prior years, the survey finds evidence that people in CDHPs and HDHPs are more likely to skimp on needed medical care or medications because of cost than are those in more comprehensive plans. Over 2005–2007, the reported rates of cost-related problems dropped among adults in CDHPs, although not among those in HDHPs.
• More cost-conscious behavior—Adults in consumer-driven plans continue to be more cost-conscious in their health care decision-making. They are significantly more likely than those in comprehensive health plans, but not substantially so, to talk with their doctors about treatment options and costs or to ask for a generic drug or a less costly drug.
• Information still limited—There have been no significant gains reported among plan enrollees in the provision of information on provider cost and quality by health plans over the three years of the survey.