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Underuse/overuse of benefits - looking for research |
pjb880
Joined: Apr 01, 2003
Posts: 14 |  Posted: 2005-08-23 07:12
As with most companies, we are moving away from full coverage to an emphasis on more employee responsibility in healthcare. We've had discussions in which opinions prevail, so I'm looking for hard data. If employees must pay more upfront for their medical care, are they more likely to forgo care when they need it? Do people actually overuse their benefits if they don't have to pay, and visit their doctor or clinic when they really don't need to? Opinions on this seem to reflect personal bias rather than fact.
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howard7
Joined: Sep 13, 2001
Posts: 2618 | Posted: 2005-08-23 15:08
If employees must pay more upfront for their medical care, are they more likely to forgo care when they need it? Depends on much the are asked to pay upfront. If you ask an employee to pay a copay of, say, $20 for a doctor's visit, it is unlikely the won't go for the visit. If the annual deductible to get to company benefits is $1,000 it is likely they will forgo medical attention if they can.
Do people actually overuse their benefits if they don't have to pay? I don" believe so nor do I believe that it should be free.
and visit their doctor or clinic when they really don't need to? Not likely. Who has that kind of time and/or can afford to be off work that much?
Opinions on this seem to reflect personal bias rather than fact. Of course they do. Why are you surprised about this? If fact you may see this occur in response to this question. It is likely there are many people who may not agree with my response.
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nork3
Joined: Feb 12, 2002
Posts: 3876 | Posted: 2005-08-23 20:10
I agree with the above. I do think that significant out of pocket costs as part of the insurance program does tend to inhibit use of the benefit, but only the discretionary stuff. The employee will use the program for necessary care.
No cost to the employee doesn't necessarily involve abuse, but it does take away the inhibition to use the program. Employees who wouldn't otherwise use healthcare benefits for a simple cold, for example, might if there were no cost associated with the carfe.
I am quite certain that the large health care insurers have detailed information on how increases in employee out of pocket costs effect overall usage. You might want to contact one of them directly.
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dionysia
Joined: Sep 13, 2001
Posts: 103 | Posted: 2005-08-26 10:27
I guess the OP read this article?
http://www.newyorker.com/fact/content/articles/050829fa_fact
Di
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KWiese
Joined: Nov 29, 2005
Posts: 2 | Posted: 2006-02-22 06:43
In December 2005 and February 2006 EBRI (Employee Benefits Research Institute) published articles on HDHP's and HSA's that might be of interest to you. Go to www.ebri.org and look for articles titled:
12/05 "Early Experience with High-Deductible and Consumer Driven Health Plans: Findings from the EBRI/Commonwealth Fund Consumerism in Health Care Survey
2/06 "Survey of Consumer -Driven Health Plans Raises Key Issues"
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coverage4all
Joined: Feb 18, 2006
Posts: 7 | Posted: 2006-07-14 09:40
There is no correct answer to the q's posted in this forum. I think of a hamster running in the spinning wheel. Often it's not the employee him/herself but a family member who is in dire need of the benefit. The tighter healthcare programs get, the more likely employees will forgo their OWN health care to focus on their family member. The result is lower productivity, sicktime, etc. At the end of the day, costs will not be reduced, just shifted elsewhere.
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ellymae
Joined: May 06, 2006
Posts: 181 | Posted: 2006-07-15 09:29
I agree with alot of what has been said, and specifically about costs being shifted elsewhere...one of those places being in training a new hire when an employee leaves to work for a company with better health coverage. Now, this is personal experience, not opinion, I administer a plan with approximately 2800 enrollees. We are self-funded. Some people do take advantage of it and go more often than necessary, but I think this is more the exception than the rule. Many, many of our associates go all year without using it at all. Would a higher cost cause them to forego care, absolutely....and in some cases that is a terrible price for them to have to pay.
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mroberts7
Joined: Apr 11, 2002
Posts: 959 | Posted: 2006-07-18 11:12
Two studies came to the conclusion that 4% of claimants make up 49% of claims and 20% of claimants make up 84% of claims. Additionally, 75% of members on a health plan will incur less than $1000 per year in claims.
Higher copays shouldn't really deter employees from going to the doctor, although it really is dependent on the plan. For example, we have a plan locally that has a $25 copay for PCP's and a $40 copay for specialists. I would assume that people can live with the $25 copay, however, the $40 copay has to make someone think twice before going to the doctor.
As for high deductible health plans/HSA's, I'm convinced that people will forego care to hoard the money in their savings accounts. When you look at what the studies are telling us, we can only hope to curb roughly 16% of claims since the huge slice of the pie is for participants racking up a fair amount of medical claims. I don't necessarily expect HSA's plans to increase overall claims, but they're not the panacea that, surprisingly, many people think they are.
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coverage4all
Joined: Feb 18, 2006
Posts: 7 | Posted: 2006-08-01 07:31
"For example, we have a plan locally that has a $25 copay for PCP's and a $40 copay for specialists. I would assume that people can live with the $25 copay, however, the $40 copay has to make someone think twice before going to the doctor."
-Aside from hating the PCP plan, many of the 4% you mention have to go to specialists for a reason: a chronic or acute illness/disability. Often, this group is the one who can least afford to pay the extra $$. I don't believe that the employer should pay it either. It should be spread across all employees. (until the current system implodes/changes at least when employers are not the sole foundation for insurance).
We're one of those families. Our 11 yr old daughter has a RARE disability. Not our fault. Not my employers. On paper we look "great" so we don't qualify for any services (funded) so we live paycheck to paycheck despite a sr. mgt level position. Lots of things are capped even after we reach the out of pocket limits & not even covered. I fight for everything that I believe should be covered. I'm reasonable & know which battles to fight. I don't go away -- it's my $$. I pay into the system.
Lifestyle isn't the only reason people get diabetes, heart disease. We need to be very careful penalizing people for these diseases. My daughter's crime -- getting genes from her mom & dad that we didn't know we had. Luckily, there's population screening now for what she has. Her sister is a carrier but alas, unless things change she'll probably have to fight to have the test paid for even tho she can prove that her older sister has expenses of $50k/yr in a good year along with a greatly diminished life expectency/quality of life.
Be careful about passing those costs -- you never know who will be paying them. It just might be you. No one is invincible.
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mroberts7
Joined: Apr 11, 2002
Posts: 959 | Posted: 2006-08-01 12:21
No matter what the solution is, some people will be "winners" and some will be "losers". If we go your route, everyone will have to pay higher taxes. And most diseases and illnesses ARE due to people's lifestyles. At least the government helps people who have excessive out-of-pocket out by allowing them to write off the medical expenses on their taxes.
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SheraO6
Joined: Nov 29, 2005
Posts: 2 | Posted: 2006-08-08 04:27
As a participant in a high deductible plan, I can truly say I avoid health care if at all possible and would actually at this point give it up. I pay out of my pocket for everything we need, I have a $3,000 deductible. I agree with the person who posted that the majority of the people do not want to go to the doctors in the first place, it wastes to much time and money. Now that the expense is put beyond my reach I will wait until it is extreme and I am left with no choice. I am a typical benefits user. And passing the cost on to the typical user will reduce your costs for medical, but it may just hurt your production costs.
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DorothyD
Joined: Aug 08, 2006
Posts: 3 | Posted: 2006-08-08 05:18
Have to disagree with some of what's been posted.
It depends on the individual - some people are truly ill and should use the system - I don't think a higher deductible will keep those folks away from the Dr. Others use it as a way to address their needs - for every sniffle, cough, and cold, they run to the doctor, because they "only" pay $15. Those folks truly do need to learn to be better consumers. Everyone should not have to pay for them.
As a whole, our country needs to be a better consumer - who is calling around to pharmacies and pricing meds? Our retirees are because their meds aren't covered at the same 'luxury' rate as current employees. We should all be calling around. Some pharmacies are meeting/beating others' pricing. We hear Walmart may be a loss-leader in Rx, in order to get folks shopping, they'll take a loss in Rx, they win everywhere else.
We should be asking for better pricing from our physician offices - we had a savvy employee contact the hospital prior to his wife having their baby to set up payments on the amounts not covered by insurance (good consumerism - would we not do that when buying a car - figure out what the payments are going to be?). The hospital offered to write off 50% if he paid up front. He agreed. 50% - why charge it in the first place, if it can easily be written off?
Something's not right in the health care system itself - and everyone should not have to pay for it. We should all be asking our physicians for alternatives, and sometimes questioning diagnoses. I watched my elderly mother, dying of cancer - go through seizures because her physician ordered a particular type of medicine. After consulting the internet and reading some really fine print in a medical journal, the med itself indicated it should not be prescribed for women over 70 or anyone with a sever diagnosis (such as cancer). Hmmm. We need to question the medical field here.
As for Gladwell's New Yorker article - perhaps if the individuals noted early in the article had spent $2.00 on toothpaste on a regular basis, then there might not be a reason they have to pull out their own teeth. Try good hygiene. I've lived paycheck to paycheck - I always managed to purchase toothpaste.
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bethsprenger
Joined: Aug 08, 2006
Posts: 1 | Posted: 2006-08-08 07:04
No one has been looking at the bill. $20 copay is what the consumer thinks some health care visits cost. This is nuts. The insurance companies and the brokers can continue to rachet up the cost of healthcare to pad their pockets while the American public looks the other way. Reform is necessary. We need to bring consumerism to the healthcare industry.
I work with a benefits administration firm where we specifically work to help employers and employees manage healthcare costs by applying consumeristic principles to benefit management. This doesn't mean that employees get stuck with huge costs. Rather, the cost is shared by the employee and the employer. The employees use financial tools (reimbursement accounts)to help them pay for higher deductibles. They can put money into reimbursement accounts because they save money in the premiums that they pay for their health insurance. Employers can offer premium savings to employees because they are not paying as much for the healthcare. The employer and employee take on more risk by buying larger deductibles thereby requiring the insurance carrier to cover less risk. This lowers premiums. Overall, employers and employees are saving money but still receiving quality healthcare.
It doesn't have to be a no-win situation for the employer or the employee. We must be wise consumers and purchase what is needed.
HSA's will be healthcare of the future. It will force consumerism back into the healthcare market. I applaude the person who wrote that individuals are calling around to check RX prices, or the gentleman who contacted hospitals prior to his wife delivering their baby to see if they could get a cheaper price if they paid up front. We need more consumers like this.
Our company has helped employees of our clients save $750,000+ in HSA's over the past two years. It can work!
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LNwriter
Joined: Jul 26, 2002
Posts: 12 | Posted: 2006-08-08 07:09
Great discussion. For several years, I worked at a small hospital in Iowa, where we were self-funded and self-administered. We had some nice perks; employee paid premiums that were nominal. We instituted copays for some services and had no maximum OOP and still there was no change in usage. I now work for physician group in the same area. Our experience has been that people who work in healthcare seem to use the health benefits more than if they didn't. Claims costs are high; our plans require employee contributions though not as costly as the hospitals in the area. Deductibles are $250/single; $750/family. Physicians and employees alike pay this. Most employees don't know how much their physician or department really pays toward their healthcare - it's a lot. I guess that makes me more appreciative of the benefit. If an employee elects a lower premium in exchange for a high deductible, it's a choice. We have a large manufacturing company in town that in the "good old days" used to pay the entire cost of healthcare for the workforce. They can't afford to do that anymore so have instituted their own plan with a lot of mandatory rules. They do give their employees the choice to see physicians out of the panel - for a price. How often I've had to keep my mouth shut because they complain they can't see a physician because they aren't in the network. They have a choice - they can see physicians in their network for a nominal copay or they can pay out of pocket to see who they want. It's a choice. We do have a benefit that pays for a yearly physicial that does not have to meet the deductible. I think that's a smart preventative tool though I bet most employees don't take advantage of that.
The question is how to keep benefits competitive while not shouldering the brunt of the expense. It's a delicate balance.
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Tamira
Joined: Aug 08, 2006
Posts: 1 | Posted: 2006-08-08 07:09
Good points are being made. It is difficult to see good solutions that we could effect. The landscape is controlled by forces much bigger than the individual consumer or even the small business choosing a health plan. The example of a consumer negotiating a write-off of the patient's portion of the bill is interesting but it is prohibited under our health plan and could result in cancellation of the benefits; from the insurer's perspective that would be increasing their portion and they've seen all the tricks. What about giving consumers the option to use chiropractors and herbalists on the same basis as medical doctors? It might increase health care costs without much medical benefit and maybe some harm. But adding these benefits wasn't done because of consumer demand; it was mandated by legislators who enjoyed the attention and funds of the industry lobbyists. Stop blaming the little guys!
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