Just the Stats: What's Known About Consumer-Driven Health

EBRI report looks at rates, enrollment and premium differences

By Stephen Miller Aug 12, 2010
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Consumer-driven health plans (CDHPs) consist of employer-funded and controlled health reimbursement arrangements (HRAs) and health savings accounts (HSAs), funded by employers or employees and employee owned. An overview report by the not-for-profit Employee Benefit Research Institute, titled What Do We Really Know About Consumer-Driven Health Plans? looks at an array of recent studies and presents a snapshot on the status of CDHPs. Among the highlights:

Employers offering CDHPs. U.S. employers offering a CDHP increased from less than 5 percent in 2005 to between 12 and 15 percent by 2009. Growth in offer rates were seen across all firm sizes. Recently, the percentage of small firms offering a CDHP declined, while large firms have continued to add a CDHP as an option.

Enrollment. Overall, 19.1 million, or 11 percent of individuals in the U.S. with private health insurance, were enrolled in a CDHP in 2009. More recent data suggest that, by 2010, 10 million people were in an HSA-eligible plan.

Premiums. Generally, premiums for CDHPs were lower than premiums for non-CDHPs. Growth in premiums varies by type of plan and over time. A number of studies tried to explain the differences in premiums between CDHPs and non-CDHPs. One found savings ranged from a high of 15.5 percent to a low of minus 4.7 percent, with average savings of 4.8 percent.

However, the study found that most of the savings was attributable to young, healthy workers choosing CDHPs and concluded that once typical risk- and benefit-adjustment factors were taken into account, CDHPs saved only 1.5 percent. There is strong evidence that, initially, CDHP enrollees will be healthier than non-CDHP enrollees, but over time the CDHP population has a significantly higher illness burden.

Premiums by Plan Type

In 2009 (the most recent data available), premiums for individual and family coverage were:




Employee-only coverage




Family coverage




Source: Kaiser Family Foundation, cited by the Employee Benefit Research Institute

Impact of CDHPs on preventive services. The studies agree that use of preventive services did not change (upward or downward) as a result of the CDHP.

Impact of CDHPs on medication adherence. The studies found that, overall, use of brand-name prescription drugs fell among CDHP enrollees. And while there was some offset from increased use of generic drugs, some enrollees stopped their use of prescription drugs. CDHP enrollees increased their use of the mail-order pharmacy option. Overall, use of prescription drugs among CDHP enrollees with certain chronic conditions fell or did not increase when enrollees met their deductible. One study found that the financial incentives of the plan were not sufficient in driving behavior and that educational outreach is important.

Need for further research. Despite the growing body of evidence on the effect of CDHPs on cost and quality, many questions remain about these plans. For example, little research has addressed the impact of these accounts on the use of services and on spending. Individuals might use health care services differently depending on how much money is being contributed to the account, especially relative to the deductible, amounts rolled over and portability of the account.

Another View

The Society for Human Resource Management's 2010 Employee Benefitssurvey report, based on a poll of SHRM members in February 2010, showed the following percentage of respondents saying they provided a consumer-directed health plan in 2010 versus 2008:









Source: Society for Human Resource Management

Stephen Milleris an online editor/manager for SHRM.

Related ArticlesSHRM:

Future Bright for Health Savings Accounts, Says Policy Analyst, SHRM Online Benefits Discipline, September 2010

CDH Plan Growth Continued in 2010, SHRM Online Benefits Discipline, September 2010

Large Employers Project 2011 Health Plan Costs to Rise 8.9%; Shift to Consumer-Directed Health Plans Continues, SHRM Online Benefits Discipline, August 2010

Enrollees in Health Reimbursement Arrangements Spend Less, GAO Finds, SHRM Online Benefits Discipline, August 2010

Controlling Health Costs: Success Tips Shared, SHRM Online Benefits Discipline, July 2010

Increased Health Care Cost Shifting Expected in 2011, SHRM Online Benefits Discipline, June 2010

Employers Change Health Benefits to Cut Costs, Alter Behavior, SHRM Online Benefits Discipline, March 2010

Studies Quantify Savings with Consumer-Driven Health Plans, SHRM Online Benefits Discipline, February 2010

Related ArticleExternal:

Americans Cut Back on Visits to Doctor[using high-deductible plans], Wall Street Journal, July 2010

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