RESUMEN
OBJECTIVE: To identify the degree of selection into consumer-directed health plans (CDHPs) versus traditional plans over time, and factors that influence choice and temper risk selection. DATA SOURCES/STUDY SETTING: Sixteen large employers offering both CDHP and traditional plans during the 20042007 period, more than 200,000 families. STUDY DESIGN: We model CDHP choice with logistic regression; predictors include risk scores, in addition to family, choice setting, and plan characteristics. Additional models stratify by account type or single enrollee versus family. DATA COLLECTION/EXTRACTION METHODS: Risk scores, family characteristics, and enrollment decisions are derived from medical claims and enrollment files. Interviews with human resources executives provide additional data. PRINCIPAL FINDINGS: CDHP risk scores were 74 percent of traditional plan scores in the first year, and this difference declined over time. Employer contributions to accounts and employee premium savings fostered CDHP enrollment and reduced risk selection. Having to make an active choice of plan increased CDHP enrollment but also increased risk selection. Risk selection was greater for singles than families and did not differ between HRA and HSA-based CDHPs. CONCLUSIONS: Risk selection was not severe and it was well managed. Employers have effective methods to encourage CDHP enrollment and temper selection against traditional plans.
Asunto(s)
Conducta de Elección , Familia , Planes de Asistencia Médica para Empleados/estadística & datos numéricos , Factores de Edad , Seguro de Costos Compartidos , Femenino , Humanos , Masculino , Factores de Riesgo , Factores Sexuales , Factores SocioeconómicosRESUMEN
OBJECTIVES: There is a debate regarding the effect of cost sharing on immunization, particularly as the Affordable Care Act will eliminate cost sharing for recommended vaccines. This study estimates changes in immunization rates and spending associated with extending first-dollar coverage to privately insured children for four childhood vaccines. METHODS: We used the 2008 National Immunization Survey and peer-reviewed literature to generate estimates of immunization status for each vaccine by age group and insurance type. We used the Truven Health Analytics 2006 MarketScan Commercial Claims and Encounters Database of line-item medical claims to estimate changes in immunization rates that would result from eliminating cost sharing, and we used the Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey to determine the prevalence of coverage for patients with first-dollar coverage, patients who face office visit cost sharing, and patients who face cost sharing for all vaccine cost components. We assumed that once cost sharing is removed, coverage rates in plans that impose cost sharing will rise to the level of plans that do not. RESULTS: We estimate that immunization rates would increase modestly and result in additional direct spending of $26.0 million to insurers/employers. Further, these payers would have an additional $11.0 million in spending associated with eliminating cost sharing for children already receiving immunizations. CONCLUSIONS: The effects of eliminating cost sharing for vaccines vary by vaccine. Overall, immunization rates will rise modestly given high insurance coverage for vaccinations, and these increases would be more substantial for those currently facing cost sharing. However, in addition to the removal of cost sharing for immunizations, these findings suggest other strategies to consider to further increase immunization rates.
Asunto(s)
Seguro de Costos Compartidos , Vacunación/economía , Adolescente , Niño , Preescolar , Encuestas de Atención de la Salud , Vacuna Neumocócica Conjugada Heptavalente , Humanos , Lactante , Vacuna contra el Sarampión-Parotiditis-Rubéola/economía , Vacunas Meningococicas/economía , Vacunas contra Papillomavirus/economía , Vacunas Neumococicas/economía , Estados Unidos , Vacunación/estadística & datos numéricos , Vacunas Conjugadas/economíaRESUMEN
In the health insurance exchanges that will come online in 2014, consumers will be able to compare health plans with respect to actuarial value, or the percentage of health care costs that a plan would pay for a standard population. This analysis illustrates the out-of-pocket costs that might result from plans with various plan designs and actuarial values. We find that average out-of-pocket expense declines as actuarial values rise, but two plans with similar actuarial values can produce very different outcomes for a given person. The overall affordability of a plan also will be influenced by age rating, income-related premium subsidies, and out-of-pocket subsidies. Actuarial value is a useful starting point for selecting a plan, but it does not pinpoint which plan will produce the best overall value for a particular person.
Asunto(s)
Análisis Actuarial , Conducta de Elección , Participación de la Comunidad , Planes Médicos Competitivos , Seguro de Salud , Financiación Personal , Costos de la Atención en Salud , Humanos , Evaluación de Resultado en la Atención de Salud , Estados UnidosRESUMEN
The Affordable Care Act creates state-based health exchanges that will begin acting as a market place for health insurance plans and consumers in 2014. This paper compares the financial protection offered by today's group and individual plans with the standards that will apply to insurance sold in state-based exchanges. Some states may apply these standards to all health insurance sold within the state. More than half of Americans who had individual insurance in 2010 were enrolled in plans that would not qualify as providing essential coverage under the rules of the exchanges in 2014. These people were enrolled in plans with an actuarial value below 60 percent, which means that the plans covered less than that proportion of the enrollees' health expenses. Many of today's individual health plans are below the "bronze" level, the lowest level of plan that can be sold through exchanges. In contrast, most group plans in 2010 had an actuarial benefit of 80-89 percent and would qualify as highly rated "gold" plans in the exchanges. To sell to ten million new buyers on the exchanges, insurers will need to redesign benefit packages. Combined with a ban on medical underwriting, the individual insurance market in a post-health reform world will sharply contrast with the market of past decades.
Asunto(s)
Cobertura del Seguro/organización & administración , Seguro de Salud , Adulto , Anciano , Anciano de 80 o más Años , Seguro de Costos Compartidos , Bases de Datos Factuales , Humanos , Cobertura del Seguro/clasificación , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Persona de Mediana Edad , Patient Protection and Affordable Care Act , Estados UnidosRESUMEN
Enrollment is increasing in consumer-directed health insurance plans, which feature high deductibles and a personal health care savings account. We project that an increase in market share of these plans--from the current level of 13 percent of employer-sponsored insurance to 50 percent--could reduce annual health care spending by about $57 billion. That decrease would be the equivalent of a 4 percent decline in total health care spending for the nonelderly. However, such growth in consumer-directed plan enrollment also has the potential to reduce the use of recommended health care services, as well as to increase premiums for traditional health insurance plans, as healthier individuals drop traditional coverage and enroll in consumer-directed plans. In this article we explore options that policy makers and employers facing these challenges should consider, including more refined plan designs and decision support systems to promote recommended services.
Asunto(s)
Participación de la Comunidad , Ahorro de Costo/economía , Planes de Asistencia Médica para Empleados/economía , Seguro de Salud/organización & administración , Planes de Asistencia Médica para Empleados/estadística & datos numéricos , Humanos , Cobertura del Seguro , Estados UnidosRESUMEN
OBJECTIVE: To investigate the effects of high-deductible health plans (HDHPs) and consumer-directed health plans (CDHPs) on healthcare spending and on the use of recommended preventive care. STUDY DESIGN: Retrospective study. METHODS: We analyzed claims and enrollment data for 808,707 households from 53 large US employers, 28 of which offered HDHPs or CDHPs. We estimated the effects of HDHP or CDHP enrollment on healthcare cost growth between 2004 and 2005 using a difference-in-difference method that compared cost growth for families who were enrolled in HDHPs or CDHPs for the first time in 2005 with cost growth for families who were not offered HDHPs or CDHPs. Control families were weighted using propensity score weights to match the treatment families. Using similar methods, we examined the effects of HDHP or CDHP enrollment on the use of preventive care and the effects of HDHP or CDHP offering by employers on the mean cost growth. RESULTS: Families enrolling in HDHPs or CDHPs for the first time spent 14% less than similar families enrolled in conventional plans. Families in firms offering an HDHP or a CDHP spent less than those in other firms. Significant savings for enrollees were realized only for plans with deductibles of at least $1000, and savings decreased with generous employer contributions to healthcare accounts. Enrollment in HDHPs or CDHPs was also associated with moderate reductions in the use of preventive care. CONCLUSIONS: The HDHPs or CDHPs with at least a $1000 deductible significantly reduced healthcare spending, but they also reduced the use of preventive care in the first year. This merits additional study because of concerns about enrollee health.
Asunto(s)
Participación de la Comunidad , Ahorro de Costo/métodos , Deducibles y Coseguros , Planes de Asistencia Médica para Empleados/economía , Gastos en Salud/tendencias , Adulto , Femenino , Humanos , Masculino , Ahorros Médicos , Persona de Mediana Edad , Medicina Preventiva , Estudios Retrospectivos , Estados Unidos , Adulto JovenRESUMEN
Based on analyses of individual market health plans sold through ehealthinsurance and enrollment information collected from individual market carriers, this article profiles the individual health insurance market in 2007, before health reform. The article examines premiums, plan enrollment, cost sharing, and covered benefits and compares individual and group markets. Premiums for the young are lower than in the group market but higher for older people. Cost sharing is substantial in the individual insurance market. Seventy-eight percent of people were enrolled in plans with deductibles for single coverage, which averaged $2,117. Annual out-of-pocket maximums averaged $5,271. Many plans do not cover important benefits. Twelve percent of individually insured persons had no coverage for office visits and only 43% have maternity benefits in their basic coverage. With the advent of health exchanges and new market rules in 2014, covered benefits may become richer, cost sharing will decline, but premiums for the young will rise.
Asunto(s)
Reforma de la Atención de Salud/economía , Beneficios del Seguro/economía , Cobertura del Seguro/economía , Seguro de Salud/economía , Seguro de Costos Compartidos/estadística & datos numéricos , Deducibles y Coseguros/economía , Humanos , Estados UnidosRESUMEN
Account-based health plans (ABHPs), which combine high-deductible plans with either health reimbursement arrangements (HRAs) or health savings accounts (HSAs), have gained popularity in recent years. Because there is growing evidence these plans are indeed engaging consumers and moderating cost increases, employers will need ABHP design options as they strive to bring costs under control in coming years. Some observers, however, are now concerned that benefits standards introduced by federal health care reform will undermine these plans, and many in the business community anticipate new health benefits mandates will drive up employers' total health care costs. The authors show that although the Patient Protection and Affordable Care Act (PPACA) of 2010 includes numerous provisions that will likely increase costs for employers, the law also accommodates, and may even foster, HSAs and HRAs.
Asunto(s)
Planes de Asistencia Médica para Empleados/economía , Ahorros Médicos , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Control de Costos , Estados UnidosRESUMEN
It's often assumed that high-cost health insurance plans--sometimes called "Cadillac" plans--provide rich benefits to plan subscribers. Health reform provisions that treat these plans like luxuries may be misguided. Only 3.7 percent of variation in the cost of family coverage can be explained by benefit design (actuarial value). Benefit design plus plan type (HMO, PPO, POS, or high-deductible plans) explains 6.1 percent of this variation. Industry type and medical costs in the region also play a role. Most variation in premiums, however, remains largely unexplained.
Asunto(s)
Planes Médicos Competitivos/estadística & datos numéricos , Análisis Costo-Beneficio/tendencias , Seguro de Salud/economía , Impuestos/legislación & jurisprudencia , Humanos , Estados UnidosRESUMEN
This paper compares health plans currently available on the individual market with employer-sponsored plans. Points of comparison include the scope of benefits, cost-sharing provisions, premiums, expected out-of-pocket costs, and actuarial value. We draw from the 2007 KFF/HRET Health Benefits Survey, our own survey of individual-market plans, the MarketScan medical claims database, and a computer simulation of medical claims. We find that in 2007, employment-based plans covered 80 percent of all charges paid by the plan and the member, while individual plans covered 64 percent. For most people, premiums and out-of-pocket costs were more affordable in tax-advantaged employer plans than in individual-market plans. Proposed health reforms would fundamentally alter the plan offerings available to Americans, particularly those offered in the individual market.
Asunto(s)
Planes de Asistencia Médica para Empleados/organización & administración , Fondos de Seguro/tendencias , Análisis Costo-Beneficio , Planes de Asistencia Médica para Empleados/economía , Humanos , Cobertura del Seguro/estadística & datos numéricos , Fondos de Seguro/estadística & datos numéricos , Estados UnidosRESUMEN
Based on simulated bill paying, this paper examines trends in comprehensiveness of coverage, out-of-pocket spending for medical services, underinsurance, and the affordability of employer-based insurance from 2004 to 2007. Data are from MarketScan medical claims and an annual survey of employer health benefits. Health plans covered slightly fewer expenses in 2007 than in 2004, but out-of-pocket spending grew more than one-third because of growth in overall health spending. For people at 200 percent of poverty, the percentage spending more than 10 percent of their income out of pocket on premiums plus services increased from 13 percent to 18 percent.
Asunto(s)
Planes de Asistencia Médica para Empleados/economía , Gastos en Salud/tendencias , Cobertura del Seguro/tendencias , Enfermedad Crónica/economía , Costos de la Atención en Salud , Estado de Salud , Humanos , Pacientes no Asegurados , Estados UnidosRESUMEN
Using multiple databases, this paper examines recent trends in the affordability and comprehensiveness of small-group and individual health insurance markets in California. Both became less affordable over the study period. In 2006, a single person age 32-52 earning the median income who purchased individual insurance spent on average 16 percent of income on premiums and out-of-pocket medical expenses. For individual insurance, the share of medical expenses paid by insurance as opposed to patients declined from 2002 to 2006. In the small-group market, premiums rose more than 50 percent from 2003 to 2006, but the proportion of claims paid by insurers for a standardized population remained constant.
Asunto(s)
Honorarios y Precios/tendencias , Financiación Personal/tendencias , Gastos en Salud/tendencias , Seguro de Salud/economía , Análisis Actuarial , Adulto , California , Planes de Asistencia Médica para Empleados/economía , Sistemas Prepagos de Salud/economía , Humanos , Seguro de Salud/estadística & datos numéricos , Seguro de Salud/tendencias , Pacientes no Asegurados , Persona de Mediana Edad , Modelos Econométricos , Organizaciones del Seguro de Salud/economía , Estados UnidosRESUMEN
This article provides the first national estimates of actuarial values and out-of-pocket spending from the era of nonrestrictive managed care that began in the late 1990s. Employer plans paid about 84 percent of total medical expense for those with employer-sponsored coverage in 2004, about 1 percent less than in 2000, and high users faced potential out of pocket spending in the thousands of dollars when they received a portion of their care out of network. Since 2004, more employers have offered plans with higher deductibles coupled with employer-funded personal accounts. These arrangements can result in low out of pocket costs for many employees, but high users will face substantially higher costs. Many employers adopting high-deductible plans are not contributing to personal accounts. Those who are concerned about higher out-of-pockets might consider income-related cost sharing, educational efforts to communicate the savings that can result from using in-network providers, and continued availability of managed care options that limit out-of-pocket spending.
Asunto(s)
Deducibles y Coseguros , Planes de Asistencia Médica para Empleados/organización & administración , Análisis Actuarial , Recolección de Datos , Planes de Asistencia Médica para Empleados/tendencias , Estados UnidosRESUMEN
Demand for consumer-directed health care (CDHC) is growing among purchasers of care, and early evidence about its effects is beginning to emerge. Studies to date are consistent with effects predicted by earlier literature: There is evidence of modest favorable health selection and early reports that consumer-directed plans are associated with both lower costs and lower cost increases. The early effects of CDHC on quality are mixed, with evidence of both appropriate and inappropriate changes in care use. Greater information about prices, quality, and treatment choices will be critical if CDHC is to achieve its goals.
Asunto(s)
Comportamiento del Consumidor/economía , Ahorros Médicos/estadística & datos numéricos , Participación del Paciente , Deducibles y Coseguros , Planes de Asistencia Médica para Empleados , Reforma de la Atención de Salud , Gastos en Salud , Humanos , Servicios de Información , Selección Tendenciosa de Seguro , Ahorros Médicos/normas , Calidad de la Atención de Salud , Estados UnidosRESUMEN
This paper reports national and state findings on the generosity or actuarial value of U.S. employer-based plans and adjusted premiums in 2002. The basis for our calculations is simulated bill paying for a large standardized population. After adjusting for the quality of benefits, we find from regression analysis that adjusted premiums are 18 percent higher in the nation's smallest firms than in firms with 1,000 or more workers. They are 25 percent higher in indemnity plans and 18 percent higher in preferred provider organizations than in health maintenance organizations. The generosity of coverage increased from 1997 to 2002.