As I’ve said a few times before, today’s consumer-directed health care plans (CDHP) are not much different from the $100 deductible major medical plans of forty years ago. (That $100 is now equivalent to over $600) Although advocates loudly proclaim CDHPs as a solution to the health care crisis, experience to date indicates that the adoption rate is quite low and the impact on cost is modest at best.
If consumerism is going to have any material effect on health care costs and utilization, it will have to reflect the realities of the health care purchasing decision process and the demographics and health status of the insured population, and recognize the lack of useful data on health care procedure prices and provider quality.
Other than that…
An excellent synopsis of these issues and recommendations for greatly improving CDHP programs is provided by Paul Ginsburg et al from the Center for Studying Health System Change. Here are the highlights –
— incenting healthy and risk reduction behaviors can have a material impact on compliance – some employers are funding their workers’ HSA accounts based in part on the workers’ compliance with wellness screening and improvement programs.
— rather than applying the deductible blindly across all types of treatments for all conditions, some employers are considering reducing the cost-sharing for services that reduce key risks while increasing cost-sharing for services that are more elective in nature.
— prescription drug benefits are under close scrutiny, with some employers (Pitney Bowes is perhaps the best known) greatly reducing copays for drugs focused on hypertension, hyperlipidemia, asthma, and diabetes. This approach directly addresses one of the major concerns with CDHPs; the high deductible is linked to lower compliance with maintenance meds.
— employee income is directly related to ability to afford health care and health insurance. Seems pretty obvious, but the CDHP enabling legislation (up until the most recent HSA legislation passed in December 2006) blindly ignored this reality.
What does this mean for you?
With these modifications, CDHP programs, and health care reform efforts as well, can add an intelligent dose of consumerism to health care. Without them, it’s more spoiled wine in new bottles.
