Consumer-Directed Health Enrollment Reached 22 Million in 2010

Those in high-deductible or consumer-directed plans were more likely to factor costs into their decisions

By Stephen Miller Dec 15, 2010

The ranks of Americans enrolled in high-deductible health plans (HDHPs), which are often linked to account-based consumer-directed health plans (CDHPs), reached 22 million in 2010, according to a December 2010 report by the not-for-profit Employee Benefit Research Institute (EBRI).

With CDHPs, plans with deductibles of at least $1,000 for employee-only coverage are linked to tax-preferred savings or spending accounts that workers and their families can use to pay their out-of-pocket health care expenses. The most common CDHPs are health savings accounts (HSAs), which are funded by the employer or employee and are portable (employees take these accounts with them on termination), and health reimbursement arrangements (HRAs), which are funded solely by the employer and are not portable.

Participation in CDHPs continues to grow, EBRI found in its sixth annual Consumer Engagement in Health Care Survey, which analyzed the behavior and attitudes of 4,509 U.S. adults ages 21 to 64 with private health insurance coverage. Among the findings:

Enrollment in CDHPs rose to 5 percent of the privately insured population (5.7 million people) in 2010, up from 4 percent in 2009.

Enrollment in HDHPs, which may or may not be linked to account-based CDHPs, increased to 14 percent of the privately insured population (17.2 million people) in 2010, up from 13 percent in 2009.

“The number of people who are enrolled in so-called consumer-driven private health care plans is slowly growing,” said Paul Fronstin, director of EBRI’s Health Research and Education Program and author of the report. “And as employers continue to look for ways to manage health care cost increases, they are turning to these account-based plans.”

More Cost-Conscious Behavior

Employment-based health benefits are the most common form of private health insurance in the United States, but skyrocketing health expenses have forced employers to seek ways to control their costs.

EBRI found that enrollees in CDHPs and HDHPs exhibit more cost-conscious behaviors than those in traditional health care plans such as preferred-provider organizations (PPOs) and health maintenance organizations (HMOs):

Examples of Cost-Conscious Decision-Making

Consumer-directed health plans (CDHPs)

High-deductible health plans (HDHPs)

Traditional health plans (e.g., PPOs and HMOs)

Checked to see whether the plan would cover specific care




Asked for a generic drug instead of a brand name




Developed budget to manage health care expenses




Checked price of service before getting care




Used online cost tracking tool provided by health plan




Source: EBRI.

Among other findings:

CDHP enrollees are more engaged in a health risk assessment or health promotion program. Three-quarters of CDHP enrollees participated in a health risk assessment program, compared with 60 percent of traditional plan enrollees. Similarly, 52 percent of CDHP enrollees participated in a health promotion program, compared with 41 percent of traditional plan enrollees.

Financial incentives are not a factor, but the use of health information technology (HIT) is.Financial incentives were no more a factor for CDHP enrollees than for traditional plan enrollees when it came to participating in wellness programs. However, CDHP and HDHP enrollees were more likely than traditional plan enrollees to choose a doctor based on his or her use of health information technology (HIT). Generally, about one-half or more of CDHP and HDHP enrollees are likely to choose a doctor based on his or her use of HIT, whereas between 40 to 50 percent of traditional plans enrollees are likely to do so.

Health status is better.In 2010, 9 percent of adults enrolled in CDHPs, 12 percent in HDHPs and 15 percent of those with traditional coverage smoked cigarettes. People in CDHPs were also more likely to exercise in all years of the survey except 2010, and they were less likely to be obese compared with adults enrolled in a traditional health plan in some years, including 2009 and 2010.

• Income no longer higher; education differences remain. While in the past, adults in CDHPs were significantly more likely than those with traditional health coverage to have a high household income, most of the income differences were not present in 2010. However, CDHP and HDHP enrollees were more likely than traditional plan enrollees to be highly educated.

Stephen Milleris an online editor/manager for SHRM.​

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