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Cost Conscious and Engaged in Health Care Decisions


While enrollment in consumer-driven and high-deductible health plans grew slowly in 2013, these individuals proved to be more cost conscious than those in traditional plans.

Adults in consumer-driven health plans or high-deductible health plans were more cost conscious than those in traditional plans, according to a new survey.

The 2013 EBRI/Greenwald & Associations Consumer Engagement in Health Care Survey reported slow growth in consumer-driven health plans, from 9.6% in 2012 to 9.7% this year. Enrollment in high-deductible plans increased two percentage points to 18%, though.

“Once again, we found that [consumer-driven health plan] enrollees were more likely to use resources to pick their health plan, more likely to use cost information before getting health care services, and more likely than traditional-plan enrollees to take advantage of various wellness programs, such as health-risk assessments, health-promotion programs, and biometric screenings,” said Paul Fronstin, director of EBRI’s Health Research and Education Program and co-author of the report.

The survey identified those with a deductible of at least $1,000 for individuals, or $2,000 for families, and a health savings account (HSA) or health reimbursement arrangement (HRA) as being in a consumer-driven plan. Those with the same deductibles but who did not have an account, including those eligible who hadn’t opened an HSA, were in the high-deductible plan group.

According to the survey results, those in a consumer-driven plan were more likely to have checked if a plan would cover care; asked for a generic drug instead of a brand name; talked to their doctors about prescription options and costs or about other treatment options and costs; asked a doctor to recommend less costly prescriptions; developed a budget to manage health care expenses; checked the price of a service before getting care; and used an online cost-tracking tool provided by the health plan.

There is also evidence, based on the behaviors of the adults in consumer-driven plans, to suggest that they are more likely than those in traditional plans to be engaged in their choice of health plan.

Enrollment in HSAs grew in 2013, with the number of people with HSAs or enrolled in an HSA-eligible plan up 16% year over year. Overall, 15% of those with private insurance were in an HSA-eligible plan, but hadn’t opened the account. Meanwhile, HRA enrollment fell.

While EBRI didn’t conclude whether the differences in engagement could be attributed to differences in plan design or whether the plan designs simply attract certain individuals, there were differences in the underlying characteristics of enrollees, according to Fronstin.

“Adults in a [consumer-driven health plans] were less likely to smoke than were adults in a traditional plan, and they were significantly more likely to exercise,” he wrote in the report. “People in a [consumer-driven health plan] were also less likely to be obese compared with adults enrolled in a traditional health plan. [Consumer-driven health plan and high-deductible health plan] enrollees were also more likely than traditional-plan enrollees to be highly educated.”

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