Putting cCnsumers at Risk in Health Care: A Policy Evaluation and Interpretation of Consumer-directed Health Benefits

• Main Author: McNeill, Dwight Nelson
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2003
• Subjects: Consumer-driven health plans; Health care; Health care management; Health risk assessment; Public administration; Public policy
• ISBN: 9780493948621; 0493948627

As employers face accelerating health insurance premium growth, the demise of its paragon to cost control (managed care), and a persistent, soft economy, they are turning to their employees to take on more risk in health insurance. This dissertation is a policy evaluation of consumer-directed health benefits (CDHB)—a health insurance product with design features that include a savings account, large deductible, catastrophic insurance, and information supports—focused on the impact on employees and their families. A comprehensive and synthetic framework for evaluating future policy options is developed to guide the analysis. A variety of analytic lenses and methods are used to address theoretic validity, feasibility, diffusion, and implementation and key outcomes including health, financial security, wages, insurance coverage, cost-sharing, and cost growth. Overall, CDHB does not represent a cost shift to consumers nor does it disadvantage the most vulnerable as opponents assert. However, the distributional consequences are profound if universally applied—the healthy reduce out-of-pocket payments by more than 50% whereas those with slight/moderate illnesses incur a cost shift of $40 billion. There is no reasonable evidence that CDHBs will reduce the ranks of the uninsured, improve efficiency, or enhance health. It may increase the rate of cost growth and reduce take-home pay. Diffusion and implementation challenges will dilute its potency. Market share is estimated at 10% by 2009. CDHBs favor those who need financial security the least. It is more a slogan than an innovation, more employer-driven than consumer-driven, and more about risk than about choice. It is unlikely to harness the enormous human and financial capital that consumers can contribute to health care reform. Three program recommendations are made toward the evolution of consumer-directed plans including more information on risk to empower and protect employees, a focus on prescription drugs, and a formula for balance in CDHB design. Recommendations for research include longitudinal designs, replication, evaluation of pioneer firms, and analyses of participant and cost-effectiveness models.