Americans would much rather choose a health plan from a set of options their employers select than to be given an employer-funded account to purchase their own plan, a new study shows.
Two-thirds of adults surveyed preferred having employers choose health plan options, with majorities of both Democrats and Republicans supporting that approach.
The study, released Thursday by the Commonwealth Fund, also revealed that people care more about being able to choose their own doctors than having a choice of health plans.
"What we're finding is that whatever way you cut it, it looks like the type of choices that people prefer are about health-care providers, not about health-care plans, and they're not so eager to abandon the employer-based system," said study author Jeanne M. Lambrew, associate professor of health policy at George Washington University in Washington, D.C.
The findings call into question whether policymakers ought to be pushing health savings accounts as a way to reduce health costs and give people more control over how they spend their health-care dollars. Lambrew's analysis suggests it may not be what most people want.
"We saw a public backlash against very closed HMOs in the 1990s," she recalled. "We may see a similar backlash against these types of policies given the fact that people may not want them, and they prefer a type of system in which we still have employers involved in making these decisions."
Greg Scandlen, founder of a newly formed grassroots lobbying organization called Consumers for Health Care Choices, argued that this interpretation is flawed. "This is looking at things the way politicians look at things," he said. "They're looking for 50-plus percent support of an idea, which is not the way markets work."
This survey found that one-third of the people prefer choosing their own health plans, he added, "and one-third of the market is huge."
Currently, more than 1 million Americans receive health care through a high-deductible plan paired with a health savings account, or HSA, according to a study by America's Health Insurance Plans.
An HSA is a relatively new type of investment account. It gives people a tax-free way to save for medical expenses. Contributions to the HSA may be carried over year-to-year to pay for future medical care. Or, the account holder may withdraw funds as needed to cover current expenses, including doctor and hospital bills, prescription drugs and over-the-counter medications.
President Bush has endorsed HSAs as a way of reigning in the rising cost of health care in the United States. But critics of this approach worry that it will erode the current employer-based system of health insurance.
Using data from the Commonwealth Fund's own biennial health insurance survey, Lambrew examined whether people really want more choice and control over their health plan options, as HSA proponents insist. The survey captures data from a nationally representative sample of 3,293 working-age adults.
The data suggest people value provider choice more highly than health plan choice. About 12 percent of those with only one health plan -- offering, in other words, no other choice of plan -- were likely to be dissatisfied with their health care. On the other hand, the dissatisfaction rate was more than twice as great (26 percent) among those individuals given no choice as to which provider to go to for their care.
Additionally, 67 percent of people who had no choice of where to go for their care indicated that a choice of health plans is very important. That compares with 55 of those given lots of provider choices by their plan. In contrast, just 37 percent of people restricted to one choice of health plan deemed having multiple health plan choices as very important.
"So, ironically, the people with no choice of plan didn't really feel like it was a problem," Lambrew said. "But the people who have very limited choice of doctors did feel like if they could just have more choices, they could get out of this box."
Based on these new findings, Lambrew urged policymakers to "think twice" about moving away from the traditional employer-based system.
Scandlen, however, doesn't think policymakers should bet on any single approach. "I don't think everyone should be in an HSA plan," he said. "Some people prefer HMOs, and they should be able to do that, too."
More information
For more on employer-sponsored health insurance, visit the Agency for Healthcare Research and Quality. To find out about health savings accounts, see The HSA Insider.
