Engaged or Worried?
Consumer engagement in healthcare is the goal of conservative health reform advocates. The logic is that engaged, informed healthcare consumers are smarter consumers. Are they? High Deductible Health Plans (HDHP’s) are promoted as a way to improve consumer engagement. The theory is that the more money the covered employee has at risk, the more she will pay attention to the services she purchases, and exercise greater discretion. The Employee Benefits Research Institute suggests that its recent survey of employees benefits plans demonstrates this.
But does this survey demonstrate that employees with HDHP’s are better consumers? Or does the research showed that employees who buy HDHP’s are simply price-sensitive, and (perhaps) not accessing services that they truly need?
Who’s got the monkey
In a famous research study reported in the Harvard Business Review, researchers looked at delegation and reverse delegation of responsibility within corporate environments. The point of the HBR article was to alert managers to inappropriate reverse delegation. In other words, don’t let employees inappropriately shift responsibility for their tasks onto management. Are HDHP’s a tool for inappropriately shifting responsibility for health risks from the employer to the employee? What we are seeing within employer sponsored health plans is risk shifting from the company toward the employees. HDHP’s are an important tool in this shift.
Smart v. Scared
The insurance industry and corporations want the same thing: to reduce their costs and keep their employees healthy and productive. The skyrocketing costs of health insurance premiums has made this challenging. Employees, on the other hand, are trying to protect themselves with reasonable health insurance premiums, while still trying to make ends meet. Knowing that the costs of even a minor medical event can be overwhelming, there is a high level of motivation to acquire and maintain health insurance. With a HDHP, the employee may feel that she has met the minimum obligation of protecting herself and her family, while reducing her monthly out-of-pocket costs. But this short-term economy may result in poor choices and frightening consequences.