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Underuse/overuse of benefits - looking for research
Benefits & Compensation
Underuse/overuse of benefits - looking for research
Exchange ideas about health plans, retirement, work/life benefits, and employee assistance.
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 dat
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Forums » Topic Forums » Benefits & Compensation » Underuse/overuse of benefits - looking for research
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Underuse/overuse of benefits - looking for research
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Underuse/overuse of benefits - looking for research
posted at 8/23/2005 3:11 AM EDT
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Posts: 14
First: 4/1/2003 Last: 2/14/2006 |
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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Underuse/overuse of benefits - looking for research
posted at 8/23/2005 11:08 AM EDT
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Posts: 2442
First: 2/12/2000 Last: 9/14/2011 |
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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Underuse/overuse of benefits - looking for research
posted at 8/23/2005 4:10 PM EDT
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Posts: 3870
First: 2/12/2002 Last: 11/2/2009 |
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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Underuse/overuse of benefits - looking for research
posted at 8/26/2005 6:27 AM EDT
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Posts: 31
First: 10/16/2000 Last: 7/10/2007 |
I guess the OP read this article?
http://www.newyorker.com/fact/content/articles/050829fa_fact Di |
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Underuse/overuse of benefits - looking for research
posted at 2/22/2006 1:43 AM EST
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Posts: 2
First: 11/29/2005 Last: 2/22/2006 |
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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Underuse/overuse of benefits - looking for research
posted at 7/14/2006 5:40 AM EDT
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Posts: 7
First: 2/18/2006 Last: 6/12/2007 |
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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Underuse/overuse of benefits - looking for research
posted at 7/15/2006 5:29 AM EDT
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Posts: 198
First: 5/6/2006 Last: 8/29/2011 |
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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Underuse/overuse of benefits - looking for research
posted at 7/18/2006 7:12 AM EDT
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Posts: 1047
First: 4/11/2002 Last: 9/14/2011 |
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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Underuse/overuse of benefits - looking for research
posted at 8/1/2006 3:31 AM EDT
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Posts: 7
First: 2/18/2006 Last: 6/12/2007 |
"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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Underuse/overuse of benefits - looking for research
posted at 8/1/2006 8:21 AM EDT
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Posts: 1047
First: 4/11/2002 Last: 9/14/2011 |
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. |
Forums » Topic Forums » Benefits & Compensation » Underuse/overuse of benefits - looking for research
