While there is some evidence that high-deductible insurance designs are waning in popularity, at least among larger employers, they cover a significant segment of workers and are still growing. The 14th annual Employee Benefits Research Institute survey of Consumer Engagement in Health Care asked over 2000 adults questions regarding their use of insurance and health care. (EBRI Research) 85% of participants, all aged 18-64, had insurance through an employer and the rest had purchased individual coverage. Compared to members with traditional insurance designs, the high-deductible enrollees were more highly educated and had higher incomes. They also generally reported being in better health, although they were more likely to smoke. The high-deductible members were more likely to look for cost-comparison information before seeking care, but less likely to report finding useful data. One third of these people reported delaying care during the year due to costs, compared to 18% of members in traditional plans. While both traditional and high-deductible plan members had higher levels of concern about their financial situation and future, high-deductible ones had greater levels of anxiety, particularly around losing coverage if they are laid off, being able to afford out-of-pocket costs, being able to retire and having enough money in retirement. That seems somewhat odd, since these members are higher-income, but perhaps they have higher expectations for life-style or are more realistic about the future.
In terms of some specific behaviors, 55% of high-deductible members, compared to 41% of traditional plan enrollees, checked their coverage before seeking care. 41% versus 33% checked for physician quality ratings; 41% versus 32% ask for generic drugs; 40% versus 29% talk to doctors about drug costs and treatment options; 37% versus 31% talk to doctors about other treatment category options and costs; 25% versus 14% use an online cost tracking tool offered by their plan and 25% versus 14% have a budget to help manage health care costs. These people were also more likely to participate in biometric screenings if offered, but less likely to take up offers of reimbursement for fitness club memberships. Big questions remain unanswered in regard to imposing more cost-sharing on people, including whether they are able to distinguish between needed and un-needed care and whether their health outcomes are unaffected by having high levels of cost-sharing.