A new survey suggests that high deductible health plans (HDHPs) can be a good news/bad news proposition: although they succeed in making plan enrollees better-informed consumers, they also are associated with negative outcomes such as delaying care because of cost concerns.

The survey, conducted by Employee Benefit Research Institute (EBRI) and Greenwald & Associates, is an annual study of consumer attitudes. Now in its 14th year, the latest study surveyed more than 2,000 adults, 85 percent of whom are enrolled in employer-based health plans.

The research is increasingly relevant due to the fact that the number of Americans enrolled in HDHPs continues to rise. The study notes that between 2007 and 2018, the percentage of individuals under age 65 enrolled in high-deductible health plans increased from 17.4 percent to 46 percent, a 264 percent increase.

More likely to search for information, but…

One good news/bad news aspect of the EBRI report is its “engaged consumers” findings. HDHPs have long been seen as a way to help consumers become smarter shoppers when it comes to health care decision-making. By giving consumers more skin in the game through higher deductibles, these plans sought to encourage enrollees to do more research and cost-comparison.

And the survey found HDHP enrollees doing just that. “More than one-third (39 percent) of HDHP enrollees versus 25 percent of traditional plan enrollees tried to find cost information in the last two years before receiving care,” the report says.

However, the results of those efforts were somewhat mixed: more HDHP enrollees report searching for cost information than traditional plan enrollees, but the study shows a higher percentage of traditional plan enrollees report actually finding information when they search for it.

The complexities of finding cost information may be affecting these results; it's possible that HDHP enrollees are more likely to search for harder-to-find information.

Informed consumers

Across the board, the HDHP enrollees showed more cost-conscious behavior. They were more likely than those with traditional coverage to say that they had checked whether their plan would cover care or medication; they were more likely to check the quality rating of a doctor or hospital before receiving care; they more often asked for a generic instead of a brand name drug or talked to their providers about options; and they were more likely to use an online cost-tracking tool provided by the health plan.

HDHP enrollees were also more likely than traditional plan enrollees to report that their employer offered them biometric screenings, financial wellness resources, and reimbursement for all or part of fitness memberships. But HDHP enrollees did not universally exhibit better health behaviors in this area. “While they were more likely to be offered reimbursement for fitness club membership, just over a quarter of [HDHP enrollees] participated in such available programs, compared to 42 percent of traditional health care plan enrollees.”

The study also noted that HDHP participants showed cost-consciousness in another way: “HDHP enrollees were more likely than traditional plan enrollees to note that their health insurance premiums would have been higher had they not participated in the employer's wellness program,” the study says.

Delaying care, worrying about finances

The EBRI study found that the biggest difference in cost-conscious behavior is that HDHP enrollees were nearly twice as likely to report that they had delayed medical care because of cost. “One-third of HDHP enrollees reported delaying care, whereas 18 percent of traditional plan enrollees delayed care because of costs,” the study notes.

The study also found an interesting pair of facts: even though HDHP enrollees tended to have higher income than traditional plan enrollees, they also were more likely to report they had major financial concerns.

The mixed messages coming from the survey, the authors concluded, may influence decision making by employers. “Concerns over the financial well-being of workers may be what's holding employers back from adopting HDHPs more broadly,” they write.

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Instant Insights /

HDHP enrollees are better-informed, but they're still skipping care

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