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By December 20, 2011Commentary

According to the Employee Benefit Research Institute, in 2011 about 27.7 million adults were covered by high-deductible health plans, with or without access to a health savings account feature.   (EBRI Report)   This represents about 23% of the population, a growth of 4% over 2010.  The deductibles were at least $1000 for an individual and $2000 for a family.  Among people who have access to an HSA or HRA only about two-thirds are actually setting up or using them.  While HDHPs or CDHPs are still relatively new, a significant portion of the insured population has now been in such a plan for at least three years, which provides more data regarding utilization and other factors under the plan and may give a sense of how much, if at all, people change their behavior when covered by this benefit design.

People with high-deductible plans, and especially those with accounts attached to them, tend to be more aware of their benefit structure.  These people are also more likely to ask for generic drugs, talk to their physicians about prescription and other options, develop a health care budget, check prices of services and use online tools than are people in more traditional benefit structures.  In terms of provider cost and quality data provided by the health plan, consumer-directed plan enrollees were as likely as traditional plan members to have access to that kind of information but were more likely to seek it from other sources as well.   CDHP enrollees were more likely to use a health risk assessment and to have an incentive for engaging in wellness or health promotion activities.

The extent of cost-conscious behavior by CDHP enrollees has not changed during the years EBRI has been doing the survey, which suggests that longer time in a plan does not build up greater and greater cost-consciousness.  Regardless of plan type, about 90% of people felt their doctor communicated well with them and about 75% felt the physician worked with them to make realistic changes in their health behaviors.  Seventy percent thought it was important that the doctor take responsibility for coordinating their care, be available by phone and work to improve their health, not just treat medical problems.  Equal proportions of plan enrollees were interested in the select network concept but only around 35% expressed even a modest interest in the idea.  About 40% of the people surveyed had a smartphone and about 7% a tablet computer.  About a quarter of those people used the device for a health-related purpose.

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