Casting doubt over the promise of consumer-driven healthcare, most working adults prefer traditional employer-sponsored coverage to account-based options, according to a study released last week by the Commonwealth Fund. And working adults value having a broad choice of providers over more plan options, according to the study.
Based on a random national survey of 3,293 Americans ages 19 to 64, the report found that nearly three-quarters of respondents with job-based coverage, or 74%, preferred their employers to select a set of health plans for them rather than fund a spending account that employees could use to buy their own coverage.
Among those with employer-based insurance, 26% of respondents who had no choice of doctor reported dissatisfaction with their healthcare, compared with only 12% of those who had no choice of health plan. And a higher percentage of adults with individual insurance complained of having limited or no choice in where to go for care than those with employer-sponsored coverage -- 27% vs. 17%. The telephone survey was conducted from September 2003 through January 2004.
The findings challenge the growing notion that health savings accounts and expansion of the individual insurance market will revitalize the nation's healthcare system, said Jeanne Lambrew, associate professor of health policy at George Washington University and the study's author. "Policymakers who advocate for a consumer-directed model often use the rationale that it would give patients greater choice and control over, and thereby greater satisfaction with, their healthcare. These data don't support that," Lambrew said. "Policymakers, beware. We could be in for another backlash, much like we saw" in the '90s against managed-care plans.
Hospitals remain cautious about the consumer-driven movement, even as some have adopted such plans for their employees. Many hospitals fear that widespread adoption of high-deductible plans could boost their bad debt by forcing them to cover of the cost of treating patients who cannot meet the high out-of-pocket requirements (Jan. 3, p. 26).
The study comes as employer-sponsored coverage continues to erode in the face of yearly premium increases. According to the Kaiser Family Foundation, 60% of companies offered health insurance in 2005, down from 69% in 2000.
The report jibes with some previous studies, which have found a disconnect between employers' growing enthusiasm for consumer-driven options and employees' continued resistance to them. According to the Kaiser foundation, even as the proportion of employers offering high-deductible plans climbed to 20% in 2005 from 5% in 2003, few employees have signed on. For example, just 3.5% of covered employees are now enrolled in high-deductible plans paired with savings accounts.
The Blue Cross and Blue Shield Association plans to release the results of its research on consumer satisfaction with consumer-directed plans on Sept. 26, along with a new initiative to give Blues patients more power in consumer-directed plans.