Changing the employer-sponsored health plan system: The views of employees in large firms

Health Affairs

Volumn 18, Issue 4, 1999, Pages 112-117

  Lave, Judith R ^a   Peele, Pamela B ^b   Black, Jeanne T ^c   Evans III, John H ^d   Amersbach, Gabriele ^e  

^a Department of Health Economics ^*

^b UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH   (United States)

^c UNIVERSITY OF CALIFORNIA   (United States)

^d UNIVERSITY OF PITTSBURGH   (United States)

^e TUFTS UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CONSUMER; FORECASTING; HEALTH INSURANCE; HUMAN; INFORMATION PROCESSING; INSURANCE; UNITED STATES;

CONSUMER SATISFACTION; FOCUS GROUPS; FORECASTING; HEALTH BENEFIT PLANS, EMPLOYEE; HUMANS; INSURANCE BENEFITS; MANAGED CARE PROGRAMS; UNITED STATES;

EID: 0033162489     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.18.4.112     Document Type: Article

References (23)

1. P. Fronstin, Source of Health Insurance and Characteristics of the Uninsured, EBRI Issue Brief no. 192 (Washington: Employee Benefit Research Institute, 1997).
2. M. Pauly, Health Benefits at Work: An Economic and Political Analysis of Employment-Based Health Insurance (Ann Arbor University of Michigan Press, 1997), 95-96.
3. These decisions are not made in a vacuum and are influenced both by the nature of the competition for the firm's product and by the types of employees that the firm hires.
4. There are other problems associated with the current system as well. For a general discussion of problems associated with the current tax treatment of health insurance, see M. Pauly, "Taxation, Health Insurance, and Market Failure in the Medical Economy," Journal of Economic Literature (June 1986): 629-675; and M. Feldstein and B. Friedman, "Tax Subsidies, the Rational Demand for Insurance, and the Health Care Crisis," Journal of Public Economics (April 1977): 155-178.
5. There are other problems associated with the current system as well. For a general discussion of problems associated with the current tax treatment of health insurance, see M. Pauly, "Taxation, Health Insurance, and Market Failure in the Medical Economy," Journal of Economic Literature (June 1986): 629-675; and M. Feldstein and B. Friedman, "Tax Subsidies, the Rational Demand for Insurance, and the Health Care Crisis," Journal of Public Economics (April 1977): 155-178.
6. There are limited tax subsidies for health insurance that is purchased privately, but they are much less generous than those for health insurance obtained through employers.
7. Patient Experiences with Managed Care: A Survey (New York: Commonwealth Fund, 1995).
8. Pauly, Health Benefits at Work;
9. A.B. Kreuger and U.E. Reinhardt, "The Economics of Employer versus Individual Mandates," Health Affairs (Spring II 1994): 34-53;
10. and R. Ehrenberg and R. Smith, Modern Labor Economics, 3d ed. (Boston: Scott, Foresman, and Company, 1988), 394-406.
11. C. Gavora, How Health Insurance Mandates Misdiagnose the Disease, Backgrounder No. 1108 (Washington: Heritage Foundation, 10 April 1997).
12. There have been innumerable proposals to do this over the years. The most recent articulation of this policy was a statement by the Consensus Group, a group of policy analysts, primarily but not exclusively associated with conservative organizations, who were brought together by the Galen Institute. See Consensus Group, A Vision for Reform: Consumer-Driven Health Care Reform (Washington: Galen Institute, July 1998).
13. American Medical Association, Rethinking Health Insurance: The AMA's Proposals for Reforming the Private Health Insurance System (www.ama-assn.org/ ad-com/18nov98.htm).
14. See K. Davis and C. Schoen, Managed Care, Choice, and Patient Satisfaction (New York: Common-wealth Fund, August 1997);
15. and R.J. Blendon et al., "Understanding the Managed Care Backlash," Health Affairs (July/August 1998): 80-94.
16. This is not an all-inclusive sample of large employers. We sampled employers representing a variety of industries (hospital, educational, banking, and manufacturing) in which there had been some recent changes in health insurance offerings. We chose not to include public organizations or retail businesses.
17. The majority of the employers who denied us access to their employees stated that they were in transition - from mergers, to "downsizing," to union negotiations. Some companies had a policy of holding focus groups only under specific circumstances. One company indicated a willingness to participate but only if it could select the participants.
18. The research team felt that including top management or human resources personnel might stifle free discussion in the focus groups.
19. Although large employers play these roles, small employers might not.
20. U.S. Congressional Budget Office, The Tax Treatment of Employment-Based Health Insurance (Washington: CBO, March 1994);
21. and CBO, Rising Health Care Costs: Causes, Implications, and Strategies (Washington: CBO, April 1991), 78.
22. Managed Care Consumer Protections Offered by Medium and Large Employers (Menlo Park, Calif.: Henry J. Kaiser Family Foundation, November 1998).
23. Prospective Payment Assessment Commission, Medicare and the American Health Care System: Report to the Congress (Washington: ProPAC,June 1996).