520:, "In the consumer-driven model, consumers occupy the primary decision-making role regarding the healthcare they receive." Goodman points to a McKinsey study which found that CDHC patients were twice as likely as patients in traditional plans to ask about cost and three times as likely to choose a less expensive treatment option, and chronic patients were 20% more likely to follow treatment regimes carefully.
579:(1974–1982) is considered "one of the best experimental social science studies ever conducted". In general, most studies, starting with the RAND study, conclude that increasing the costs (co-payments and deductibles) to the patient reduces the consumption of healthcare, but it reduces the consumption of both appropriate and inappropriate care, and the reduction is greater for low-income patients.
595:
pregnancy, with gestational diabetes, pre-term labor, cesarian section and neonatal intensive care, would be priced at $ 287,000. Under some consumer-directed health plans, the cost to the family would be $ 6,000, less than some traditional policies. But under other consumer-directed health plans, the cost to the family would be as high as $ 21,000.
583:, in summarizing the RAND study, reported that visits to doctors and hospitals decline with higher cost sharing, "although for low income families such cutbacks reduced their use of beneficial as well as unnecessary services and was estimated to have increased rates of death from preventable illness."
594:
The Kaiser Family
Foundation studied how consumer-driven health plans cover pregnancy. They found wide variations in cost sharing. Pregnant women could face exposure to high out-of-pocket costs under consumer-driven health plans, particularly when complications arise. In one scenario, a complicated
437:
Consumer-driven healthcare plans had their origin in the U.S. in the late 1990s. It was developed as a business model for health ventures. They were designed to engage consumers more directly in their healthcare purchases. The initial conceptual model made cost and quality information available to
428:
Proponents suggest the plans increase free-market variables in the healthcare system, fostering competition, which, in turn, lowers prices and stimulates improvements in service. Critics argue they cause those less wealthy and educated to avoid needed and appropriate healthcare because of the cost
456:
in
December 2003. The law expanded medical savings accounts, renaming them Health Savings Accounts and created tax incentives to encourage adoption of high-deductible health plans. Banks were empowered to create HSAs, which deliver tax-free interest to the holders, who can then withdraw money tax
527:
are implemented in the United States, high deductible plans and the concept of consumer-driven healthcare may become more popular. Although new federal tax subsidies will help reduce health insurance rates for many consumers, individuals and families that do not qualify, are expected to consider
611:
found widespread satisfaction among HSA customers, a survey published in 2007 by employee benefits consultants Towers Perrin came to the opposite conclusion; it found that employees currently enrolled in such plans were significantly less satisfied with many elements of the health benefit plan
586:
However, proponents counter these findings with studies indicating that CDHCs have broad appeal, provide a new option for the uninsured, and are leading to new incentives for people to be more engaged in managing their health. One study found that the levels and trends of use of preventive and
1574:
As compared to traditional health benefit plan participants, ABHP members are less comfortable with the level of financial risk their plan exposes them to, less likely to understand how the plan works, less favorable about how easy it is to use the plan, less favorable about the clarity of
413:
In this system, health care costs are first paid for by an allotment of money provided by the employer in an HSA or HRA. Once health care costs have used up this amount, the consumer pays for health care until the deductible is reached, after this point, it operates similar to a typical
457:
free to pay for qualified expenditures. To qualify for an HSA, the purchaser must also have a qualifying high-deductible health insurance plan. Over time, participants are allowed to contribute more (cumulatively) to the savings account than would be required to fulfill their annual
476:
By April 2007, some 4.5 million
Americans were enrolled in HSAs; more than a fourth of those were previously uninsured. Only people enrolled in high-deducible health plans are eligible for HSAs. Another type of account in the consumer driven healthcare model is
465:
penalty so long as the funds are used only for qualified medical expenses. Further enhancements to HSAs went into effect in 2007. The combination of tax breaks for premiums and the health savings account as well as a tax subsidy to pay for the catastrophic
860:
Haviland, Amelia M.; Marquis, M. Susan; McDevitt, Roland D.; Sood, Neeraj (1 May 2012). "Growth Of
Consumer-Directed Health Plans To One-Half Of All Employer-Sponsored Insurance Could Save $ 57 Billion Annually".
1562:
629:. No correlation was found. "Patient ratings of healthcare are easy to obtain and report, but do not accurately measure the technical quality of medical care," said John T. Chang, UCLA, the study's lead author.
508:
By 2007, an estimated 3.8 million U.S. workers, about 5% of the covered workforce, were enrolled in consumer-driven plans. About 10% of firms offered such plans to their workers, according to a study by the
591:(PPO) plans. The authors concluded that "eople enrolled in CDHPs such as those we studied do not underuse preventive services to any greater degree than do those in traditional PPOs."
232:
445:
220:
649:, a system in which price transparency is essential. CDHPs cannot effectively decrease health care costs without the ability for consumers to compare prices prior to use.
410:
which has cheaper premiums but higher out of pocket expenses, and as such are seen as a cost effective means for companies to provide health care for their employees.
362:
1631:
Chang JT, Hays RD, Shekelle PG, et al. (May 2006). "Patients' global ratings of their health care are not associated with the technical quality of their care".
653:
1479:
Rowe JW, Brown-Stevenson T, Downey RL, Newhouse JP (2008). "The effect of consumer-directed health plans on the use of preventive and chronic illness services".
732:
461:
for a given year (although annual limits on pre-tax contributions are well below the annual deductible), and any unused portions of the account accrue without
1749:
513:. In 2010, 13% of consumers in employee-sponsored health insurance programs had consumer-driven health plans. In 2016, 29% of employee were covered by a CDHP.
1674:
394:
plan that allows employers or employees to utilize pretax money to help pay for medical expenses not covered by their health plan. These plans are linked to
1563:"Without the Correct Approach and Implementation, Long-Term Effectiveness of Account-Based Health Plans Could Be Undermined, Towers Perrin Research Shows"
481:(HRAs), which are employer-funded, and in which employers receive the tax benefits. These accounts are available to people that do not qualify for HSAs.
214:
425:, which mandates that routine or health maintenance claims must be covered, with no cost-sharing (copays, co-insurance, or deductibles) to the patient.
657:
1212:
208:
1329:
1822:
355:
406:. Users keep any unused balance or "rollover" at the end of the year to increase future balances or to invest for future expenses. They are a
623:
asked 236 elderly patients from two managed care plans in 2005 to rate their care, and then examined care in medical records, as reported in
77:
1356:
896:
704:
809:
524:
238:
226:
348:
36:
642:
131:
1516:
608:
200:
71:
1803:"The Impact of Consumer-Driven Health Plans on Health Care Costs: A Closer Look at Plans with Health Reimbursement Accounts."
144:
784:
1795:
669:
553:
1533:
576:
557:
478:
267:
656:, they often do not use actual negotiated rates and lack quality information. Conversely, some companies such as
588:
415:
179:
173:
167:
22:
1767:
843:
620:
83:
587:
screening services by enrollees in consumer-directed health plans (CDHPs) was similar to that of enrollees in
1806:
1614:"RAND Study Finds Patients' Ratings of Their Medical Care Do Not Reflect the Technical Quality of Their Care"
978:"Awakening Consumer Stewardship of Health Benefits: Prevalence and Differentiation of New Health Plan Models"
537:
399:
149:
113:
615:
Some policy analysts say that patient satisfaction does not reflect quality of healthcare. Researchers at
1827:
625:
407:
125:
1290:"Consumer-Driven Health Care-Beyond Rhetoric with Research and Experience: Consumer-Driven Health Care"
327:
287:
1534:"Surveys Indicate Consumers Are Happy With HSA Offerings, But Want Some Changes In Custodial Accounts"
660:
have attempted to address the problem by sharing negotiated rate estimates along with quality scores.
674:
107:
572:
have all provided their own claims data for independent analyses by the Health Care Cost
Institute.
1263:
560:
have examined results of consumer-driven plans. In addition to their own research, health insurers
510:
441:
HSAs are seen by proponents as a way to make healthcare more affordable and accessible in the U.S.
305:
54:
541:
403:
1238:
449:
448:, which included provisions designed to stimulate the popularity of these plans, was passed by
395:
119:
62:
1575:
communication around benefit change and less satisfied with the basic elements of their plans.
938:
733:"Consumer-Driven Health Care: What Is It, and What Does It Mean for Employees and Employers?"
638:
604:
310:
42:
1644:
1173:
813:
607:
studies regarding consumer-driven health plans have been mixed. While a 2005 survey by the
187:
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8:
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997:
993:
934:
878:
470:
418:. Once the out-of-pocket maximum is reached, the health plan pays all further costs.
1660:
1588:
1513:
645:. Consumers are unable to make health care decisions based on cost due to a lack of
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391:
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652:
While cost-estimator tools have become available as part of a broad trend towards
528:
Health
Savings Accounts (HSAs) if they do not have employer-sponsored coverage. .
1520:
847:
580:
517:
788:
453:
333:
315:
874:
1816:
1492:
1456:
1439:
1406:
1182:
1115:
1061:
1001:
812:(Press release). America's Health Insurance Plans. 2007-04-02. Archived from
257:
1041:
787:(Press release). U.S. Department of the Treasury. 2006-12-20. Archived from
1734:
1716:
1652:
1500:
1465:
1424:
1383:"Consumer-Directed Health Care: Will It Improve Health System Performance?"
1069:
1053:
1019:
882:
785:"President Bush Signs Bill to Make Health Care more Affordable, Accessible"
760:
497:
320:
161:
1699:
Sood, Neeraj; Wagner, Zachary; Huckfeldt, Peter; Haviland, Amelia (2013).
1330:"UnitedHealth Group Reports Customers are Selecting CDHPs at a Rapid Pace"
1541:
1440:"Consumer-directed health plans and the RAND Health Insurance Experiment"
646:
484:
Other countries with experience in this type of health insurance include
281:
1123:
1091:
930:
766:. U.S. Department of the Treasury – Internal Revenue Service. 2011-01-14
1092:"The Effects of Consumer-Directed Health Plans on Health Care Spending"
473:
of lower income individuals has boosted the popularity of these plans.
458:
493:
467:
1090:
Sasso, Anthony T. Lo; Helmchen, Lorens A.; Kaestner, Robert (2010).
840:
923:
Networks
Financial Institute Policy Brief, Indiana State University
277:
48:
233:
Health
Information Technology for Economic and Clinical Health Act
1478:
66:
612:
compared to those enrolled in traditional health benefit plans.
1750:"Health Care Transparency Deserves a Serious Bipartisan Effort"
1040:
Gabel, Jon R.; Lo Sasso, Anthony T.; Rice, Thomas (July 2002).
897:"Consumer Directed Health Plans: A Step in the Right Direction"
565:
489:
1357:"Consumer-Driven Health Plans Reduce Medical Care Utilization"
826:
446:
Medicare
Prescription Drug, Improvement, and Modernization Act
221:
Medicare
Prescription Drug, Improvement, and Modernization Act
952:
561:
485:
261:
1157:"Health Care Spending: Historical Trends and New Directions"
1042:"Consumer-driven health plans: are they more than talk now?"
1698:
1264:"Encouraging signs for consumer-directed health care plans"
859:
850:, Kaiser Family Foundation, 2007-09-11, accessed 2007-10-28
1748:
Kalogeropoulos, George; Fowler, Shandon (June 21, 2018).
462:
921:
Goodman, John C. (2006). "Consumer Driven Health Care".
1288:
Gauthier, Anne K.; Clancy, Carolyn M. (28 June 2004).
810:"4.5 Million Enrolled in Health Savings Account Plans"
654:
consumer-driven health technology in the United States
1089:
957:
Carlson School of Management, University of Minnesota
1747:
705:"Understanding Consumer-Driven Health Plans (CDHPs)"
215:
Health Insurance Portability and Accountability Act
1798:. U.S. Department of the Treasury. 15 August 2011.
1701:"Price-Shopping in Consumer-Directed Health Plans"
51:/ State Health Insurance Assistance Program (SHIP)
1630:
1217:The Wall Street Journal / Pittsburgh Post-Gazette
1039:
975:
637:Healthcare markets are known for a lack of price
632:
1814:
421:CDHC plans are subject to the provisions of the
209:Emergency Medical Treatment and Active Labor Act
1675:"Does the U.S. have 'free market' health care?"
1526:
1514:Maternity care and consumer-driven health plans
1239:"Aetna Pilot Site Details Fees Paid to Doctors"
1287:
1155:Chen, Alice; Goldman, Dana (31 October 2016).
976:Rosenthal, Meredith; Milstein, Arnold (2004).
356:
78:Program of All-Inclusive Care for the Elderly
1606:
1589:"In health care, consumer theory falls flat"
1213:"Aetna to reveal what doctors really charge"
438:the consumer, usually through the Internet.
1624:
1580:
1437:
1154:
841:Employer Health Benefits 2007 Annual Survey
1565:(Press release). Towers Perrin. 2007-05-22
525:Patient Protection and Affordable Care Act
363:
349:
239:Patient Protection and Affordable Care Act
227:Patient Safety and Quality Improvement Act
1724:
1455:
1414:
1354:
1348:
1313:
1172:
1009:
969:
37:Federal Employees Health Benefits Program
1281:
1210:
1204:
598:
452:in November 2003 and signed into law by
1705:Forum for Health Economics & Policy
1645:10.7326/0003-4819-144-9-200605020-00010
1236:
1230:
1174:10.1146/annurev-economics-080315-015317
1150:
1148:
920:
889:
643:health care prices in the United States
1815:
1768:"Achieving transparency in healthcare"
1586:
1523:, Kaiser Family Foundation, June 2007.
609:Blue Cross and Blue Shield Association
1823:Health insurance in the United States
1380:
1374:
1355:Gruessner, Vera (14 September 2016).
1211:Fuhrmans, Vanessa (August 19, 2005).
1083:
1033:
727:
725:
145:Health insurance in the United States
1145:
523:In 2014, when major portions of the
1760:
1741:
72:Children's Health Insurance Program
13:
1237:Kaufman, Wendy (August 19, 2005).
1048:. Suppl Web Exclusives: W395–407.
722:
14:
1839:
1788:
1096:The Journal of Risk and Insurance
670:Consumers for health care choices
554:University of Illinois at Chicago
479:Health Reimbursement Arrangements
1796:"Health Savings Accounts (HSAs)"
1399:10.1111/j.1475-6773.2004.00284.x
1306:10.1111/j.1475-6773.2004.00272.x
1108:10.1111/j.1539-6975.2009.01346.x
994:10.1111/j.1475-6773.2004.00273.x
825:The full census is available at
577:RAND Health Insurance Experiment
558:RAND Health Insurance Experiment
268:Massachusetts health care reform
1692:
1667:
1555:
1507:
1472:
1431:
1322:
1256:
945:
589:Preferred provider organization
180:Preferred provider organization
174:Health maintenance organization
168:Exclusive provider organization
23:Healthcare in the United States
1540:. October 2005. Archived from
914:
853:
834:
802:
777:
753:
697:
633:Price and quality transparency
621:Department of Veterans Affairs
139:Private Fee-For-Service (PFFS)
84:Veterans Health Administration
59:Prescription Assistance (SPAP)
1:
1807:American Academy of Actuaries
690:
503:
432:
400:health reimbursement accounts
150:Health insurance marketplaces
16:Type of health insurance plan
1587:Wessel, David (2006-09-07).
538:Carlson School of Management
384:consumer-driven health plans
114:Health reimbursement account
7:
1633:Annals of Internal Medicine
827:http://www.ahipresearch.org
663:
626:Annals of Internal Medicine
408:high-deductible health plan
126:High-deductible health plan
10:
1844:
1161:Annual Review of Economics
740:Bureau of Labor Statistics
376:Consumer-driven healthcare
328:Fair Share Health Care Act
288:Vermont health care reform
103:Consumer-driven healthcare
31:Government health programs
1805:Public Policy Monograph,
875:10.1377/hlthaff.2011.0369
675:Flexible spending account
531:
300:Municipal health coverage
108:Flexible spending account
1772:www.modernhealthcare.com
1493:10.1377/hlthaff.27.1.113
1457:10.1377/hlthaff.23.6.107
1387:Health Services Research
1294:Health Services Research
982:Health Services Research
556:(Anthony Lo Sasso), and
511:Kaiser Family Foundation
404:medical payment accounts
306:Healthcare in California
1361:HealthPayerIntelligence
552:(Meredith Rosenthal),
542:University of Minnesota
516:According to economist
396:health savings accounts
132:Medical savings account
97:Private health coverage
1717:10.1515/fhep-2012-0028
1054:10.1377/hlthaff.w2.395
761:"2010 Publication 969"
390:) refers to a type of
336:(Howard Co., Maryland)
120:Health savings account
63:Military Health System
1595:. Wall Street Journal
1393:(4 Pt 2): 1219–1234.
1381:Davis, Karen (2004).
605:consumer satisfaction
599:Consumer satisfaction
311:Healthy San Francisco
43:Indian Health Service
1438:Newhouse JP (2004).
641:, which affects the
188:Medical underwriting
1336:. 22 September 2006
931:10.2139/ssrn.985572
680:Health care systems
536:Researchers at the
423:Affordable Care Act
402:(HRAs), or similar
1828:Health care reform
1519:2007-09-27 at the
1300:(4p2): 1049–1054.
988:(4p2): 1055–1070.
846:2007-09-15 at the
570:UnitedHealth Group
550:Harvard University
546:Stephen T. Parente
273:Oregon Health Plan
252:State level reform
201:Health care reform
155:Premium tax credit
1616:(Press release).
953:"eHealthPlan.org"
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1679:The Tennessean
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1620:. May 1, 2016.
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603:Results of
282:Connecticut
1817:Categories
1777:2019-05-18
1599:2007-07-10
1569:2007-07-10
1548:2019-12-04
1366:9 November
1340:9 November
1334:Dark Daily
1273:9 November
1248:9 November
1222:9 November
1196:9 November
1137:9 November
1075:9 November
1025:9 November
962:2007-07-10
820:2007-07-10
795:2007-07-10
770:2011-05-02
715:2021-09-20
691:References
504:Popularity
459:deductible
433:Background
330:(Maryland)
1407:0017-9124
1191:154901081
1183:1941-1383
1132:154745779
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1062:0278-2715
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617:RAND Corp
494:Singapore
468:insurance
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664:See also
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164:(CCP)
128:(HDHP)
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1657:S2CID
1268:AETNA
1187:S2CID
1128:S2CID
1120:JSTOR
764:(PDF)
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486:China
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