Summary
• Fourth annual survey: This Issue Brief presents findings from the 2008 EBRI Consumer Engagement in Health Care Survey, which provides nationally representative data regarding the growth of account-based health plans and high-deductible health plans (HDHPs) and the impact of these plans and consumer engagement more generally on the behavior and attitudes of adults with private health insurance coverage. Findings are compared with the 2005, 2006, and 2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys.
• Enrollment low but growing: In 2008, 3 percent of the population was enrolled in a consumer-driven health plan (CDHP), up from 2 percent in 2007 and 1 percent in 2006. Enrollment in HDHPs remained at 11 percent. Overall, 9.8 million adults ages 21–64 with private insurance (representing 6.6 percent of that market) were in either a CDHP or an HDHP that was eligible for an HSA, but had not opened the account.
• Higher income, better health: As before, this year’s survey found that adults in CDHPs were significantly more likely than those with traditional health coverage to have high household income, to be in better health, and to exhibit healthy behavior.
• Satisfaction gaps: CDHP enrollees in 2008 continue to have no difference in satisfaction with quality of care compared with those in traditional plans, but a satisfaction gap remains for HDHP enrollees. Differences in overall satisfaction levels (higher satisfaction with traditional plans) were reinforced in the 2008 findings.
• Choice of plan: Among individuals with employment-based health benefits, those in CDHPs were more likely than those with traditional coverage to have a choice of health plan. This contrasts with findings from 2005 and 2006, when individuals with traditional coverage were more likely to have a choice of health plan than individuals enrolled in CDHPs. Two-thirds of individuals with an employment-based CDHP reported that the employer contributed to the account. Among those eligible to contribute to an account, 15 percent contributed nothing.
• Cost-related access issues: In 2008, HDHP enrollees continued to be more likely than traditional plan enrollees to report that they had delayed or avoided getting any needed health care services because of costs. But the difference between traditional plan enrollees and CDHP disappeared, mostly because more traditional plan enrollees reported access issues due to costs.
• More cost-conscious behavior: Individuals in CDHPs and HDHPs exhibit more cost-conscious behavior in their health care decision making than individuals with traditional health insurance. • Strong interest in reduced cost sharing: There was across-the-board strong interest in consumer engagements that could lower patient cost sharing, such as select networks (medical providers with records of high quality care), health promotion programs, and using scientifically proven effective care.