Market watch: Do consumer-directed health plans drive change in enrollees' health care behavior?

Health Affairs

Volumn 27, Issue 4, 2008, Pages 1120-1131

  Dixon, Anna ^a   Greene, Jessica ^b   Hibbard, Judith ^c  

^a KING S FUND   (United Kingdom)

^b UNIVERSITY OF OREGON   (United States)

^c Department of Health Policy ^*

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; CONSUMER HEALTH INFORMATION; COST CONTROL; HEALTH BEHAVIOR; HEALTH CARE; HEALTH CARE COST; HEALTH CARE ORGANIZATION; HEALTH CARE PERSONNEL; HEALTH CARE UTILIZATION; HEALTH SERVICE; HEALTH SURVEY; HUMAN; MEDICAL CARE; MEDICAL INFORMATION; CONSUMER; COST; HEALTH INSURANCE; HEALTH SERVICES RESEARCH; LONGITUDINAL STUDY; UNITED STATES; UTILIZATION REVIEW;

CONSUMER PARTICIPATION; COST SAVINGS; DEDUCTIBLES AND COINSURANCE; HEALTH BENEFIT PLANS, EMPLOYEE; HEALTH SERVICES; HEALTH SERVICES NEEDS AND DEMAND; HUMANS; LONGITUDINAL STUDIES; MEDICAL SAVINGS ACCOUNTS; ORGANIZATIONAL CASE STUDIES; UNITED STATES;

EID: 48149092296     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.27.4.1120     Document Type: Article

References (33)

1. J.B. Christianson, S.T. Parente, and R. Feldman, "Consumer Experiences in a Consumer-Driven Health Plan," Health Services Research 39, no. 4, Part 2 (2004): 1123-1140;
2. and J.R. Gabel et al., "Employers' Contradictory Views about Consumer-Driven Health Care: Results from a National Survey," Health Affairs 23 (2004): w210-w218 (published online 21 April 2004; 10.1377/hlthaff.w4.210).
3. R.T. Jefferson, "Medical Savings Accounts: Windfalls for the Healthy, Wealthy, and Wise," Catholic University Law Review 48, no. 3 (1999): 685-723;
4. L.M. Nichols, M. Moon, and S. Wall, Tax-Preferred Medical Savings Accounts and Catastrophic Health Insurance Plans: A Numerical Analysis of Winners and Losers (Washington: Urban Institute, 1996);
5. and U.E. Reinhardt, "President Bush's Proposals for Healthcare Reform," British Medical Journal 332, no. 7537 (2006): 314-315.
6. J.C. Robinson, "Health Savings Accounts - The Ownership Society in Health Care," New England Journal of Medicine 353, no. 12 (2005): 1199-1202;
7. K. Davis, "Consumer-Directed Health Care: Will It Improve Health System Performance?" Health Services Research 39, no. 4, Part 2 (2004): 1219-1234;
8. T.H. Lee and K. Zapert, "Do High-Deductible Health Plans Threaten Quality of Care?" New England Journal of Medicine 353, no. 12 (2005): 1202-1204;
9. K. Davis, M. Doty, and A. Ho, "How High Is Too High? Implications of High-Deductible Health Plans" (New York: Commonwealth Fund, 2005);
10. and D. McNeill, "Do Consumer-Directed Health Benefits Favor the Young and Healthy?" Health Affairs 23, no. 1 (2004): 186-193.
11. These were high-deductible plans with a health savings account (HSA) or high-deductible plans without an HSA, where the deductible was at least as high as required for HSAs in 2005. See P. Fronstin and S. Collins, Early Experience with High- Deductible and Consumer-Driven Health Plans: Findings from the EBRI/Commonwealth Fund Consumerism in Health Care Survey (New York: Commonwealth Fund, 2005).
12. S.T. Parente, R. Feldman, and J.B. Christianson, "Evaluation of the Effect of a Consumer-Driven Health Plan on Medical Care Expenditures and Utilization," Health Services Research 39, no. 4, Part 2 (2004): 1189-1210.
13. Most employees were offered an indemnity plan, but it was priced approximately 50 percent higher than the PPO in 2004, so only 4 percent of the workforce selected it. We excluded these employees from our study.
14. The timing of the surveys means that the data only apply to the first six months of both 2004 and 2005; thus, nothing is known about behavior that might have been undertaken in the second half of 2004.
15. For the first round of the survey, respondents received a small incentive gift of a water bottle. In the second round, no gift was provided.
16. More details of the survey design are available in J. Greene et al., "Which Consumers Are Ready for Consumer-Directed Health Plans?" Journal of Consumer Policy 29, no. 3 (2006): 247-262.
17. The plans offered were under health reimbursement arrangements (HRAs), where the employer funds the personal care account (PCA) and unused money reverts back to the company if employment is terminated (that is, they are not portable). For discussion of the differences between HRAs and HSAs, see U.S. Government Accountability Office, Federal Employees Health Benefits Program: First-Year Experience with High-Deductible Health Plans and Health Savings Accounts (Washington: GAO, January 2006).
18. G. Claxton et al., Employer Health Benefits: 2005 Annual Survey (Menlo Park, Calif.: Henry J. Kaiser Family Foundation, 2007).
19. U.S. Census Bureau, "U.S. Census 2000 Summary File 3 (SF 3)," November 2007, http://www.census.gov/Press-Release/www/2002/sumfile3.html (accessed 21 April 2008).
20. National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey 2003 (Hyattsville, Md.: NCHS, 2005).
21. Selection issues are analyzed in more detail in Greene et al., "Which Consumers Are Ready?" Enrollees in the high-deductible CDHP tended to have higher education levels and much lower medical claims in the prior year. Enrollees in the lower-deductible CDHP had characteristics more similar to those in the PPO. This is largely consistent with other emerging evidence of favorable selection based on either age, income, or health status. See, for example, GAO, Federal Employees Health Benefits Program;
22. S.T. Parente, R. Feldman, and J.B. Christianson, "Employee Choice of Consumer-Driven Health Insurance in a Multiplan, Multiproduct Setting," Health Services Research 39, no. 4, Part 2 (2004): 1091-1112;
23. and L.A. Tollen, M.N. Ross, and S. Poor, "Risk Segmentation Related to the Offering of a Consumer-Directed Health Plan: A Case Study of Humana Inc.," Health Services Research 39, no. 4, Part 2 (2004): 1167-1188.
24. See R. Neugebauer and S. Ng, "Differential Recall as a Source of Bias in Epidemiologic Research," Journal of Clinical Epidemiology 43, no. 12 (1990): 1337-1341.
25. Respondents were asked a series of nine questions to indicate whether a doctor had told them they had a particular health condition. In addition, respondents were asked whether they had any other condition that required ongoing medical care and, if so, to name the condition.
26. J. Greene, H. Speizer, and W. Wiitala, "Telephone and Web: The Mixed-Mode Challenge," Health Services Research 43, no. 1 (2008): 230-248.
27. M.N. Marshall et al., "Public Reporting on Quality in the United States and the United Kingdom," Health Affairs 22, no. 3 (2003): 134-148.
28. K. Davis et al., "Mirror, Mirror on the Wall: An Update on the Quality of American Health Care through the Patient's Lens" (New York: Commonwealth Fund, April 2006).
29. J.H. Hibbard et al., "Consumer Competencies and the Use of Comparative Quality Information: It Isn't Just about Literacy," Medical Care Research and Review 64, no. 4 (2007): 379-394.
30. J.P. Newhouse and the Insurance Experiment Group, Free for All? Lessons from the RAND Health Insurance Experiment (Cambridge, Mass.: Harvard University Press, 1993).
31. J. Greene et al., "The Impact of Consumer-Directed Health Plans on Prescription Drug Use," Health Affairs 27, no. 4 (2008): 1111-1119.
32. J.C. Robinson, "Managed Consumerism in Health Care," Health Affairs 24, no. 6 (2005): 1478-1489.
33. Claxton et al., Employer Health Benefits.