CDHPs not Living up to Hype

March 18, 2008 ( - Consumer-driven health plans (CDHPs) or high-deductible health plans (HDHPs) combined with a tax-advantaged savings or reimbursement account are not living up to claims they would decrease the number of uninsured, encourage cost-consciousness among consumers, and increase the amount of information on the cost and quality of providers.

According to the third EBRI/Commonwealth Fund Consumerism in Health Care Survey, 7% of CDHP enrollees were uninsured before being covered by their current plan, compared with 15% of HDHP enrollees and 28% of individuals with comprehensive coverage. Adults in CDHPs are significantly more likely to consider costs in deciding about health care than those in more comprehensive plans, but the differences are not substantial, according to a press release on the survey results.

Additionally, the survey found there have not been significant gains in the amount of information on provider cost and quality given to enrollees by health plans of any type over the three years of the survey and, as in earlier years, people in CDHPs and HDHPs reported they are more likely to skimp on needed medical care or medications because of cost than are those in more comprehensive plans.

Consumer-driven plan enrollees are in better health, are less likely to smoke, are more likely to exercise, and to be white, male, and higher-income, EBRI and Commonwealth Fund said in the release. The survey results also showed enrollees in CDHPs continue to be less satisfied with their plans overall than those with more comprehensive care.

The percentage of CDHP enrollees with household incomes above $100,000 increased to 31% in 2007, up from 22% in 2005, according to the survey, while just 19% of adults with CDHPs were in households with incomes of under $50,000 in 2007, down from 33% in 2005. In addition, the survey found that 23% of HDHP enrollees were in higher-income households in 2007, up from 15% in 2005. By comparison, there was little change in the income levels of those enrolled in more comprehensive plans.

Enrollment in CDHPs with a tax-advantaged account was 2% of the privately-insured adult population in 2007, up from 1% the previous year – representing 2.3 million adults ages 21-64 with private insurance. Enrollment in HDHPs stood at 11% of the privately-insured adult population in 2007, up from 7% the previous year – representing 12.5 million people ages 21-64.

Results of the survey appear in the March 2008 EBRI Issue Brief , available at , and on the Commonwealth Fund Web site, .