Many Enrollees in Consumer-Directed Health Plans Not Satisfied, Delay Care, Survey Finds

People enrolled in consumer-directed health plans do not appear to be as satisfied with their coverage and are more likely to delay or forego care than members of traditional health plans, according to a study released Thursday by the Employee Benefits Research Institute, the Hartford Courant reports. The study is based on responses to an online questionnaire from 1,204 people ages 21 to 64. Participants had either employer-sponsored or individual insurance (Levick, Hartford Courant, 12/9).

According to the survey, 1% of privately insured U.S. residents are enrolled in a consumer-directed health plan, while 9% are enrolled in a high-deductible plan (Snowbeck, Pittsburgh Post-Gazette, 12/9). The survey finds that 42% of those in consumer-directed plans -- a high deductible plan combined with a savings account for health expenses -- and 33% who were enrolled in just high-deductible plans said they were "very" or "extremely" satisfied with their plan. By comparison, 63% of those in traditional plans said the same.

The survey found that about half of members in consumer-directed or high-deductible plans were not given another choice of insurance by an employer, which could explain the lower satisfaction rates with such plans, according to Paul Fronstin of EBRI.

Of those enrolled in consumer-directed plans, 31% spent 5% or more of their income on out-of-pocket medical bills and premiums, compared with 12% of those in traditional plans.

In addition, 35% of those in consumer-directed plans said that they delayed or avoided health services, compared with 17% of those in traditional plans (Hartford Courant, 12/9).

According to the survey, members of consumer-driven plans display more cost-conscious behavior in making health care decisions than do members of traditional plans, CQ HealthBeat reports (CQ HealthBeat, 12/9). However, the results also show that consumers in all plans believe they do not have enough information to make decisions about doctors and hospitals based on cost and quality (Pittsburgh Post-Gazette, 12/9).

The survey indicates that consumers also might not trust the information insurers give them, with 4% of people in consumer-directed or high-deductible plans and 6% in regular plans saying that insurers were their most trusted source of health care information. Doctors, followed by consumer groups, were more trusted, the survey says (Hartford Courant, 12/9).

"These findings provide evidence that high-deductible and consumer-driven plans may undermine the two basic purposes of health insurance: to reduce financial barriers to needed care and protect against high out-of-pocket cost burdens for patients," Karen Davis, president of Commonwealth Fund, which helped prepare the study, said.

However, Karen Ignagni, president and CEO of America's Health Insurance Plans, said the study "confirms other research that has revealed widespread consumer satisfaction with a variety of coverage options offered by health insurance plans" (CQ HealthBeat, 12/9).

Michael Showalter, vice president of consumer-driven health strategy and development at Cigna, said that previous studies found that chronically ill patients were not skipping care.

Robin Downey, head of product development at Aetna, said the company found that consumer-directed member with chronic conditions did not receive fewer medications or tests than those in other plans.

Robert Crane, senior vice president of research and policy development at Kaiser Foundation Health Plan, said, "We should be looking for a sweet spot between encouraging cost-conscious behavior but not going over to an area in which costs will increase long-term because people delay care" (Hartford Courant, 12/9).

A summary of the survey findings is available online.