The Employee Benefits Research Institute does an annual survey of persons covered by consumer-directed or high deductible health plans. (EBRI Report) The most recent survey shows that in 2009 about 4% of the population is in a CDHP and about 13% in a HDHP. Enrollment in these plans grows at a modest but steady rate. (For EBRI, the difference between CDHP and HDHP is that CDHP members have access to an HRA or HSA account.) From a demographic perspective, people with CDHP or HDHP tend to be more educated and have a higher income. They are also generally in better health. More persons in small firms have HDHPs.
In some prior years, enrollees in CDHP and HDHP had reported less satisfaction with quality of care than those in traditional plans. This year, however, CDHP members were as satisfied as traditional members but HDHP members continue to have less satisfaction with quality of care. In overall satisfaction with their health plan, traditional plan enrollees continue to lead both CDHP and HDHP members. HDHP members reported a number of differences on survey questions compared to CDHP enrollees. The overall thrust of these differences suggest that many companies offering HDHP are doing so solely for the cost savings and often do not couple the HDHP with increased health promotion or wellness offerings. CDHP sponsors appear to be more likely to offer such programs and to be using the plans to encourage employee engagement in their health.
Financial incentives are important to members in all types of health plans, but more important to HDHP and CDHP members. Cash incentives appeared to be the most motivating, followed by time off for participation and avoiding increased premiums. Also interesting were responses to questions about reasons for not participating in health promotion or wellness programs. The most significant reason was a belief by respondent that he or she could make changes on their own, then lack of time and feeling that he or she was already healthy. Strong interest was shown in participating in a network of high-quality physicians with lower cost-savings.
It is unclear what the impact of any reform may be on CDHP and HDHP, but they have shown growth to date and if health costs and premiums continue to increase, their prevalence will likely continue to expand. The findings of these surveys offer some interesting insights on how consumers respond to various plan design features and give guidance to those creating products and services for engaging consumers in their health and health care.