December 8, 2005, 9:00 a.m.— Americans enrolled in a relatively new type of health coverage designed to make them more cost conscious are less satisfied with their health plan than those with comprehensive health insurance and are less likely to recommend the new plans to a friend or colleague, a groundbreaking nationwide survey reported today.

High-deductible health plans (HDHPs) of $1,000 or more for individuals and $2,000 or more for families can be combined with tax-preferred savings accounts such as Health Savings Accounts (HSAs) or health reimbursement arrangements (HRAs). Employers can contribute money to HRAs and both employers and individuals can contribute to HSAs, which can then be used to pay for health care expenses not covered by the health plans. These consumer-directed health plans (CDHPs) frequently have been called the latest big idea in health insurance in the United States. By giving more responsibility for costs to the consumer and theoretically providing cost and quality information about providers, the plans are designed to encourage participants to make informed, cost-conscious decisions about their health care.

The survey also found that those covered by these new plans, both with and without savings accounts, are more likely than those with comprehensive insurance to avoid or delay needed care. When they do get care, those in consumer-directed plans encounter larger financial burdens compared with those with comprehensive insurance. But individuals in the new plans do exhibit more cost-conscious behavior in their health care decisions—as the plans intended—compared with those having comprehensive insurance, the survey found. Still, the survey said this may come at the expense of those who are sick and have low incomes. And very few people have cost and quality information from their plans to make informed decisions, the study found.

Sponsored by the nonpartisan Employee Benefit Research Institute (EBRI) and The Commonwealth Fund, which supports independent research on health care issues, the Consumerism in Health Care Survey was designed to provide reliable national data on the growth of the new type of coverage and its impact on health care consumers. It is the first national survey of its kind. A full report on the survey is published in the December 2005 EBRI Issue Brief. The report is available on both organizations' Web sites: www.ebri.org and www.cmwf.org.

Typically, a CDHP participant has a special type of savings account that is used to pay for medical costs up to a set amount and a high-deductible health plan (HDHP) that is used to pay for costs over a specified threshold. Proponents of these accounts think they will encourage individuals to become more astute health care consumers; critics worry that the high out-of-pocket costs will discourage use of needed health care services, especially among people with low incomes and/or chronic health conditions.

Employers have expressed considerable interest in the new plans in hopes they may help rein in health care costs. The survey found that 1 percent of privately insured U.S. residents ages 21-64 are enrolled in a CDHP, while another 9 percent are enrolled in an HDHP without an associated savings account. Both plans are expected to grow next year, but the survey suggested that comprehensive health plans remain far more popular—at least at this point.