Abstract
Background
The appropriateness of new consumer-directed health plan (CDHP) benefit designs for people with chronic illnesses has been questioned, but little information exists regarding the experience of chronically ill individuals in CDHPs. To contribute to a better understanding of the experience of people with chronic illnesses in CDHPs, this study analyzed survey and medical claims data from a large public employer that offered a CDHP as well as other benefit options.
Methods
An analysis of combined survey, administrative records, and medical claims data was conducted for a sample of employees participating in a large public employer’s health benefits plan. The main outcome measures were plan enrollment decision, use of information, plan rating, and spending patterns.
Results
Employees with chronic illness are equally likely as other employees to join a CDHP, to understand key plan coverage features, and to report having a particularly positive or negative experience with their plan. However, CDHP enrollees with chronic illnesses assign higher ratings to their plan than do other CDHP enrollees (p < 0.07). They are more likely than other CDHP enrollees to use informational tools (p < 0.05), more likely to anticipate spending all of their savings account dollars (p < 0.05), and more likely actually to spend more than the deductible (particularly for prescription drug expenditures [p < 0.05]). Compared with other CDHP enrollees whose spending exceeds the deductible, enrollees with chronic illnesses spend significantly more on prescription drugs.
Conclusions
Even though the CDHP benefit design was generous, relatively few employees chose the CDHP, and the CDHP was no more attractive to employees with chronic illnesses than to other employees. Furthermore, although people with chronic illnesses who chose CDHPs had some understanding of how their health savings accounts (HSAs) would work, they tended to exhaust those accounts and also spend more than the plan’s deductible. There is much more for employers to do if they want CHDP enrollees with chronic illnesses to ‘manage’ their conditions more effectively.
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References
Claxton G, Gabel J, Gil I, et al. Health benefits in 2006: premium increases moderate, enrollment in consumer-directed health plans remains modest. Health Aff 2006 Sept; 25: w476–85
Regopoulos L, Christianson JB, Claxton G, et al. Consumer-directed health insurance products: local-market perspectives. Health Aff 2006 May/Jun; 25(3): 766–73
Christianson JB, Parente ST, Feldman R. Consumer experiences in a consumerdriven health plan. Health Serv Res 2004 Aug; 39(4): 1123–39
Buntin MB, Damberg C, Haviland A, et al. Consumer-directed health care: early evidence about effects on cost and quality. Health Aff 2006 Oct; 25: w516–30
McNeill D. Do consumer-directed health benefits favor the young and healthy? Health Aff 2004 Jan/Feb; 23(1): 186–93
Swartz K. The view from here: Enron-ing health insurance. Inquiry 2001/2002; 38(4): 344–6
Hwang W, Weller W, Ireys H, et al. Out-of-pocket medical spending for care of chronic conditions. Health Aff 2001 May/Jun; 20(6): 267–78
Remler DK, Glied SA. How much more cost sharing will health savings accounts bring? Health Aff 2006 Jul/Aug; 25(4): 1070–8
Lee PV, Hoo E. Beyond consumer-driven health care: purchasers’ expectations of all plans. Health Aff 2006 Oct; 25: w544–8
Christianson J, Feldman R, Weiner JP, et al. Early experience of a new model of employer group purchasing in Minnesota. Health Aff 1999 Nov/Dec; 18(6): 100–1
Christianson JB, Feldman R. Evolution in the buyers health care action group purchasing initiative. Health Aff 2002 Jan/Feb; 21(1): 76–88
Parente ST, Feldman R, Christianson JB. Employee choice of consumer-driven health insurance in a multiplan, multiproduct setting. Heath Serv Res 2004 Aug; 39 (4 Pt 2): 1091–112
Christianson JB, Parente ST, Taylor R. Defined contribution health insurance products: development and prospects. Health Aff 2002 Jan/Feb; 21(1): 49–64
Ross MN. Consumer-directed health care: it’s not whether the glass is half-empty, but why? Health Aff 2006 Oct; 25: w552–4
Fireman B, Bartlett J, Selby J. Can disease management reduce health care costs by improving quality? Health Aff 2004 Nov/Dec; 23(6): 63–75
Jost T. Consumer-driven health care in South Africa: lessons from comparative health policy studies. J Health Biomed Law 2005; 1(2): 83–109
Acknowledgements
This article is an extension of a presentation by the authors to the International Health Economics Meeting in Barcelona, Spain, in July 2005. The project on which the article is based was funded by the Robert Wood Johnson Foundation’s initiative on Changes in Health Care Financing and Organization. We gratefully acknowledge the help provided by the administration of the University of Minnesota, and Ruth Taylor, Carlson School of Management, University of Minnesota.
The authors have no conflicts of interest that are directly relevant to the content of this study.
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Parente, S.T., Christianson, J.B. & Feldman, R. Consumer-Directed Health Plans and the Chronically I11. Dis-Manage-Health-Outcomes 15, 239–248 (2007). https://doi.org/10.2165/00115677-200715040-00005
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DOI: https://doi.org/10.2165/00115677-200715040-00005