Dallas Salisbury, EBRI chief executive officer, said, "Cost-conscious decision making is one advantage of consumer-driven plans. But the perception of those who are enrolled is that these plans do not provide the tools and resources to make decisions and that they reduce use and increase out-of-pocket spending. Overall, satisfaction is lower with consumer-driven plans than with comprehensive insurance."

"These findings provide evidence that high-deductible and consumer-driven plans may undermine the two basic purposes of health insurance: to reduce financial barriers to needed care and protect against high out-of-pocket cost burdens for patients," said Commonwealth Fund President Karen Davis. "Enrollees with low incomes or with health problems are particularly vulnerable to spending a high proportion of income on medical expenses under these types of plans."

Here are some of the major points to emerge from the survey:

• Individuals with comprehensive health insurance were more satisfied with their health plan than individuals in CDHPs and HDHPs. Specifically, 63 percent of individuals with comprehensive health insurance were extremely or very satisfied with their health plan, compared with 42 percent among CDHP enrollees and 33 percent among HDHP participants.
• About 60 percent of individuals with comprehensive insurance reported they were extremely or very likely to stay with their current health plan if they had the opportunity to switch, compared with 46 percent among CDHP enrollees and 30 percent among HDHP enrollees.
• Individuals with CDHPs and HDHPs are more likely to spend a larger share of their income on out-of-pocket health care costs plus premiums than those in comprehensive health plans. More than two-fifths (42 percent) of individuals with HDHPs and 3 in 10 (31 percent) in CDHPs spent 5 percent or more of their income on out-of-pocket costs plus premiums in the past year, compared with about 1 in 10 (12 percent) in comprehensive health plans.
• Individuals with CDHPs and HDHPs were significantly more likely to avoid, skip, or delay health care because of costs than were those with comprehensive insurance, with problems particularly pronounced among those with health problems or incomes under $50,000. About one-third of individuals in CDHPs (35 percent) and HDHPs (31 percent) reported delaying or avoiding care, compared with 17 percent of those in comprehensive health plans.
• More than 70 percent of individuals enrolled in CDHPs and 60 percent of those in HDHPs strongly or somewhat agreed that the terms of their health plans made them consider costs when deciding to see a doctor when sick or when filling a prescription. Less than 40 percent of those in comprehensive plans felt this way.
• Just 1 in 7 people in all types of plans said their plan offered information on doctors and hospitals. Moreover, just over half (54 percent) of those enrolled in CDHPs or HDHPs said they had tried to use plan information on the quality of physicians, and only 45 percent had tried to use quality information about hospitals.

"This survey finds that consumer plans do, in fact, significantly raise consumer sensitivity to costs and reduce use. But the survey also demonstrates that cost-related reductions in demand are highest among those with the most to lose—those who are sick and those who have low incomes. To the extent that the health care cost problem is a problem owned by all of us, early evidence from the consumerism movement suggests that solving it through blunt, demand-side instruments like high deductibles gives disproportionate responsibility for the problem to the most vulnerable among us."