Satisfaction with consumer-driven health plans is trending up, even as contentment with traditional plans wanes.
Those findings are part of a report from the Washington, D.C.-based Employee Benefit Research Institute (EBRI). They come from an analysis of the 2011 EBRI/MGA Consumer Engagement in Health Care Survey, as well as annual versions of that survey dating back to 2005.
EBRI defined consumer-driven health plans, or CDHPs, as insurance plans that have deductibles of at least $1,000 for individuals or $2,000 for families. To qualify as a CDHP in the report, a plan also had to be paired with an account like a health-savings account or health-reimbursement arrangement that plan members could use to pay medical expenses.
Plans labeled as traditional coverage featured either no deductibles or deductibles below CDHP levels. They were not paired with health-savings accounts or health-reimbursement arrangements. Plans falling under that definition include health-maintenance organizations, or HMOs, preferred-provider organizations, or PPOs, and other managed-care plans, according to EBRI.
Satisfaction with those traditional plans has eroded since 2005. The portion of survey respondents listing themselves as extremely satisfied or very satisfied with their overall traditional plans slipped from 61 percent in 2005 to 57 percent in 2011.
CDHPs, on the other hand, did an increasingly better job of satisfying consumers over the seven-year period. Just 41 percent of survey respondents said they were extremely or very satisfied with their CDHPs in 2005, a reading that rose to 46 percent in 2011.
The diverging trends are likely due to changes in out-of-pocket costs, according to Paul Fronstin, director of EBRI's Health Research Education Program and author of the report. Those with traditional health insurance feel changing out-of-pocket costs more directly than those with CDHP-linked spending accounts, he says.
"The difference is that you've got an account," Fronstin says. "People build up account balances, and over time they're less sensitive to costs."
EBRI's surveys show satisfaction with CDHP out-of-pocket health-care costs rising over time. Just 18 percent of CDHP members were extremely or very satisfied with those costs in 2005, but 24 percent were in 2011.
Over the same time frame, satisfaction with traditional plans' out-of-pocket costs moved in the opposite direction. In 2005, 45 percent of survey respondents were extremely or very satisfied with their out-of-pocket costs, compared with 41 percent in 2011.
Plan members have also grown happier with the quality of health care they receive under CDHPs. While 63 percent were satisfied with their CDHP health-care quality in 2005, 71 percent were satisfied in 2011. Satisfaction with traditional plans' healthcare quality, on the other hand, remained relatively flat It notched 70 percent in 2005 and 71 percent in 2011.
"Back in 2005 and 2006, just about everybody in these CDHP plans were in one for the first time," Fronstin says. "Whereas now they're not so new anymore, they're not as confusing."
Although CDHPs are satisfying members at a higher rate than before, traditional plans still have higher overall satisfaction readings, Fronstin points out. And CDHPs continued to stoke higher levels of dissatisfaction, he says.
In 2011, 17 percent of CDHP members were not too satisfied or not at all satisfied with their plans, down from 26 percent in 2005. Yet a mere 10 percent of traditional plan members voiced those levels of dissatisfaction with their health insurance in 2011, and only 8 percent did so in 2005.
Similarly, CDHP members were less likely to recommend their health plan to others or stay with it if given the opportunity to change plans.
In 2011, 41 percent of CDHP members said they would recommend their plans to others, which is lower than the 49 percent of traditional plan members who said they would do so. Meanwhile, 49 percent of CDHP members indicated they would stick with their current plans if given a chance to change, compared to 58 percent of traditional-plan members.
Fronstin has yet to find a reason for that discrepancy.
"I'm not sure what to make of that difference," he says. "It's something that I still find interesting."
EBRI also broke out a third type of plan in its report - plans it dubbed high-deductible health plans, or HDHPs. Members falling into that category had insurance similar to CDHP members, but without paired accounts for health spending.
HDHP members expressed lower satisfaction across the board. For example, 37 percent were satisfied with their overall health plan in 2011, but that was up from just 31 percent in 2005.
Members without spending accounts are likely to feel more pain paying their deductibles, according to Fronstin.
"The biggest number of people who don't get health benefits from work and get them directly from an insurance company are going to be in HDHPs," he says. "They may be out of work. It may be the only thing they can afford. Some of them are eligible for an HSA and never opened one, which would imply they don't have the money to do so."