Kaiser Study: The Good, Bad and Ugly

Ask silly questions and you get silly answers. This is confirmed by a recent Kaiser poll.

We live at a time when employers are making changes – sometimes radical changes – in their health plans to control health care costs. Many of these changes reduce benefits; but other changes give employees opportunities to manage some of their own health dollars and gain financially from making prudent purchases.

Indiscriminate polling will catch people at different phases of this process. Some people answering the poll will have plans with fewer benefits. Others will be working for employers whose benefit cuts will not come until next year or the year after that. Failure to distinguish among these differences will produce little more than people confirming that more is better than less.

In the Kaiser poll, half of the people with consumer directed health care (CDHC) said they would switch plans if given the choice, versus a third of those with traditional insurance. But this is not the right question. The right question is: for the same premium dollars, which plan provides better value? I know of only one large company (Whole Foods) that allows employees to vote on their health plan, given a fixed number of employee benefit dollars. The result: 85% or so voted to keep the CDHC plan rather than revert to traditional coverage.

As a further tip off of poor polling design in the Kaiser poll, CDHC enrollers were more likely to say they felt vulnerable to high medical bills. But for the same premium dollars, CDHC plans almost always make people less vulnerable.

On the brighter side, Kaiser reports some of the same patterns others have reported:

• More than half (57 percent) of CDHC participants are likely to ask their doctor for cost information, compared to only a third (38 percent) of traditional plan participants.
• CDHC plan enrollees are more likely (17 percent vs. 10 percent) to ask about less costly treatment alternatives.
• They were twice as likely (19% vs. 10%) to use the internet to lower the costs of prescription drugs.

And crying out for further investigation is this puzzling result: CDHC participants were more likely to report going without needed care because of cost (23% vs. 11%). But they were no more likely to report having problems paying medical bills and were less likely to have overdue medical bills. Since all previous research reports no harmful health effects from CDHC plans, the Kaiser poll results may mean nothing more than the fact that CDHC participants are able to choose between health care and other uses of money and they take advantage of that opportunity.

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