EBRI Issue Brief

Early Experience With High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey

Dec 8, 2005 32  pages


The latest “big idea”—Promoting consumerism in health care is the latest big idea in health insurance in the United States. One of the leading manifestations of this is the use of high-deductible health plans with savings accounts, such as health savings accounts (HSAs) and health reimbursement arrangements (HRAs), collectively known as consumer-driven health plans (CDHPs). The first EBRI/Commonwealth Fund Consumerism in Health Care Survey was conducted to provide reliable national data on the growth of high deductible plans and their impact on the behavior and attitudes of health care consumers. The study defines high-deductible plans as those that would qualify for federal HSA tax preferences: with deductibles of $1,000 or more for individual plans and $2,000 or more for family plans.

Lower satisfaction with consumer-driven plans—The EBRI/Commonwealth Fund Consumerism in Health Care Survey—the first national survey of its kind—found that individuals with more comprehensive health insurance were more satisfied with their health plan than individuals in high deductible plans, with or without accounts. Specifically, 63 percent of individuals with comprehensive health insurance were extremely or very satisfied with their health plan, compared with 42 percent of CDHP enrollees and 33 percent of HDHP participants. About 60 percent of individuals with comprehensive insurance reported they were extremely or very likely to stay with their current health plan if they had the opportunity to switch, compared with 46 per-cent of CDHP enrollees and 30 percent of HDHP enrollees.

Higher out-of-pocket costs—Despite similar rates of health care use, individuals with CDHPs and HDHPs are significantly more likely to spend a large share of their income on out-of-pocket health care expenses than those in comprehensive health plans. Two-fifths (42 percent) of those in HDHPs and 31 percent of those in CDHPs spent 5 percent or more of their income on out-of pocket costs and premiums in the last year, compared with 12 percent of those in more comprehensive health plans.

More missed health care—Individuals with CDHPs and HDHPs were significantly more likely to avoid, skip, or delay health care because of costs than were those with more comprehensive health insurance, with problems particularly pronounced among those with health problems or incomes under $50,000. About one-third of individuals in CHDPs (35 percent) and HDHPs (31 percent) reported delaying or avoiding care, compared with 17 percent of those in comprehensive health plans.

More cost-conscious consumers—Among people in the plans who did receive care, there is evidence that they are more cost-conscious than those in comprehensive health plans. People in the CDHPs and HDHPs were significantly more likely to say that the terms of their health plans made them consider costs when deciding to see a doctor when sick or fill a prescription, to report that they had checked whether their health plan would cover their costs as well as the price of a service prior to receiving care, and to discuss treatment options and the cost of care with their doctors. Nevertheless, they were also more likely to go without care.

Lack of information—Few health plans of any type provide cost and quality information about providers to help people make informed decisions about their health care. The study also found very low levels of trust in information provided by health plans.