What Do We Really Know About Consumer-Driven Health Plans?
August 2010
EBRI Issue Brief #345
Paperback, 28 pp.
PDF,
587 kb
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Executive Summary
ABOUT CDHPs: Employers began offering consumer-driven health
plans (CDHPs) in 2001 when a handful started offering health reimbursement
arrangements (HRAs). They then started offering health savings account
(HSA)-eligible plans after the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 included a provision to allow individuals with certain
high-deductible health plans to contribute to an HSA. This report summarizes
what is known about CDHPs, which include both HRAs and HSAs.
OFFER RATES: Surveys show that employers offering a CDHP
increased from less than 5 percent in 2005 to between 12–15 percent by 2009.
Growth in offer rates can be seen across all firm sizes. Recently, the
percentage of small firms that offered a CDHP declined while larger firms
continued to add a CDHP as an option.
ENROLLMENT: Overall, 19.1 million, or 11 percent of
individuals with private insurance, were enrolled in a CDHP in 2009. More recent
data suggest that by 2010, 10 million people were in an HSA-eligible plan.
PREMIUMS: Generally, premiums for CDHPs were lower than
premiums for non-CDHPs. A number of studies have tried to explain the
differences in premiums. One found savings ranged from 15.5 percent to a low of
–4.7 percent, with average savings of 4.8 percent. However, the study found that
most of the savings was due to younger, healthier workers choosing CDHPs and
concluded that once typical risk- and benefit-adjustment factors were taken into
account, CDHPs saved only 1.5 percent. There is strong evidence that initially
CDHP enrollees will be healthier than non-CDHP enrollees, but that over time the
CDHP population has a significantly higher illness burden.
IMPACT OF CDHPs ON PREVENTIVE SERVICES: The studies agree
that use of preventive services did not change (upward or downward) as a result
of the CDHP.
IMPACT OF CDHPs ON MEDICATION ADHERENCE: The studies found
that overall use of brand-name prescription drugs fell and, while there was some
offset from increased use of generic drugs, some enrollees stopped their use of
prescription drugs. CDHP enrollees increased their use of the mail-order
pharmacy option. Overall use of prescription drugs among CDHP enrollees with
certain chronic conditions fell, or did not increase when enrollees met their
deductible. One study found that the financial incentives of the plan are not
sufficient in driving behavior, and that educational outreach also matters.
NEED FOR FURTHER RESEARCH: Despite the growing body of
evidence on the effect of CDHPs on cost and quality, there are many unanswered
questions about these plans. Most of the research to date has focused on
HRA-based plans. Little systematic research has been conducted on HSA-eligible
enrollees. The differences between these plans are significant enough to warrant
separate analyses. Also, most of the research to date has ignored the impact of
the account on the use of services and on spending. Individuals may use health
care services differently depending on how much money is being contributed to
the account, especially relative to the deductible, amounts rolled over, and
portability of the account.
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