EBRI Issue Brief

Consumer Engagement in Health Care: Findings from the 2016 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey

May 25, 2017 28  pages


The EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (CEHCS) provides reliable national data on the growth of high-deductible plans and their impact on the behavior and attitudes of health care consumers with employment-based coverage or individually purchased coverage. It also looks broadly at consumer engagement and value-based health insurance design. Now in its 11th year, it is co-sponsored by the Employee Benefit Research Institute (EBRI) and Greenwald & Associates with support from seven private organizations.

The 2016 survey was conducted online August 11-24, using the Ipsos consumer panel. A total of 3,295 adults with private health insurance coverage through an employer, purchased directly from a carrier, or purchased through a government exchange participated in the survey. However, most survey participants (82 percent) received coverage through an employer. The data were weighted by gender, age, education, region, income, and race/ethnicity to reflect the actual proportions in the population ages 21-64 with private health-insurance coverage.

This Issue Brief identifies the key findings of the 2016 survey:

  • Health plans with high deductibles are increasingly common. Fourteen percent of privately insured adults were enrolled in a consumer-driven health plan (CDHP)—a health plan associated with a health savings account (HSA) or health reimbursement arrangement (HRA); 14 percent also were enrolled in a high-deductible health plan (HDHP)—a plan with a deductible of $1,300 or more for single coverage; at least $2,600 for family coverage—not linked to an HSA or HRA; and 73 percent were enrolled in more traditional coverage. Among individuals with traditional coverage, a growing number have the option to choose a CDHP. Those who choose a CDHP are also remaining enrolled for a longer time.
  • More than half (56 percent) of CDHP enrollees opened an HSA, taking advantage of growing employer contributions. Among individuals enrolled in CDHPs, 56 percent (16.3 million) opened an HSA, 19 percent (5.5 million) were in an HRA, and 25 percent (7.3 million) were enrolled in an HSA-eligible health plan but had not opened an HSA. It was more common for employers to contribute to an HSA in 2016 than in the past, and the dollar amount also increased. Seventy-eight percent of CDHP enrollees reported that their employer contributed to the account in 2016, up from 67 percent in 2014. Furthermore, 20 percent of CDHP enrollees reported an employer contribution of at least $2,000 in 2016, up from 10 percent in 2014. Similarly, 42 percent reported an employer contribution of $1,000?$1,999 in 2016, up from 36 percent in 2014.
  • Consumer behaviors are linked to CDHP enrollment. Adults in a CDHP and those in an HDHP were more likely than those in a traditional plan to exhibit a number of cost-conscious behaviors. For example, those in a CDHP were more likely to say that they had checked whether the plan would cover care (54 percent CDHP vs. 44 percent traditional); asked for a generic drug instead of a brand name (48 percent CDHP vs. 37 percent traditional); and that they had used an online cost-tracking tool provided by the health plan (31 percent CDHP vs. 20 percent traditional). CDHP and HDHP enrollees were also more likely than traditional-plan enrollees to report that they tried to find cost information before getting care. Nearly one-half of HDHP enrollees, and 43 percent of CDHP enrollees said they had searched for the cost information, compared with 32 percent among traditional-plan enrollees.
  • CDHP enrollees are part of a robust health program strategy. Individuals enrolled in CDHPs were more likely than those enrolled in HDHPs or with traditional coverage to report that they had a choice of health plans. Two-thirds of CDHP enrollees had a choice of health plan, compared with 49 percent among HDHP enrollees and 50 percent among traditional plan enrollees. CDHP enrollees were more likely than traditional-plan enrollees to report that they participated in biometric screening programs when offered: Over 80 percent of CDHP enrollees participated, compared with 64 percent among traditional-plan enrollees.

These survey findings suggest that the inclusion of a high deductible—whether via a HDHP or CDHP—is correlated with more engaged individuals. Further, given that CDHP enrollees are more consistently offered funds for their HSA, had a choice of health plans at enrollment and offered wellness programs, CDHP enrollees are more likely to consistently engage in those cost-conscious consumer behaviors.