Friday, December 08, 2006

Another Independent Study Rejects Effectiveness of CDHPs

Consumer-driven health plans (CDHPs) are all the craze on the right these days, but they just can't seem to catch a break when it comes to finding an independent study that backs their effectiveness at lowering costs and expanding coverage.

The latest study comes from the Employee Benefits Research Institute (EBRI), a nonpartisan employer group, and the Commonwealth Fund, a nonpartisan research group.

Here are some of the key findings of the study:
  • Participants in CDHPs were more likely than people in comprehensive plans to report delaying or skipping necessary medical care because of the cost.
  • Participants in CDHPs continue to be less satisfied with their health plan than people in comprehensive plans.
  • Even though federal law states that HSAs can be set up so that preventive care is excluded from the deductible, more than 1/2 of people currently in CDHPs must pay for preventive care out of their deductible (hence, reducing the likelihood that people will receive preventive care).
  • While participants in CDHPs tend to exhibit more cost-conscious behavior in some areas, they are no more likely to do so in many areas than people in comprehensive health plans.
  • Participants in CDHPs were less likely to receive cost and quality care information from their health plans than people enrolled in comprehensive plans.
  • The uninsured are more likely to enroll in comprehensive health plans than CDHPs.
  • Those who opt to enroll in CDHPs tend to be healthier, thereby leaving sicker people enrolled in traditional plans, which, in turn, increases the overall cost of the health care system because risk is less decentralized.
These findings come from a September 2006 survey, and they mirror very closely the findings from the same survey conducted in 2005.

An article in Rueters also noted how hospitals are not too fond of CDHPs, thus far. According to the American Hospital Association, people who are coming in for care with CDHPs are not prepared to pay their high deductibles, which is increasing the amount of unpaid medical bills. This, consequently, raises the cost of care for everyone else in the system as expenses are shifted to those who do pay.

As I said earlier in the week, I could care less how the growing health care crisis in Wisconsin and the US is addressed. If consumer-driven care was the answer, then great. But, as independent studies like this one make clear, it's not -- at least not in standalone form.

The Wisconsin Health Plan, which I wrote about in more detail yesterday and back in March, actually includes many aspects of consumer-driven health care, which is what likely gives it the most broad political appeal of all the plans currently before the state legislature (although, evidently, it's still not conservative enough for GOP leaders in the Assembly).

But what gives the WHP a chance a success, while standalone CDHPs have largely failed, is that it does something to alter the structure of the current system -- namely, by introducing a tiered format to the state's health plan set up -- rather than merely latching onto the existing structure that has proven to be inefficient (driving costs up) and unequal (driving coverage down).

And that's the biggest point that needs to be kept in mind as this health care reform debate moves forward in the coming year. Any successful reform needs to be fundamental. Tinkering just won't cut it.

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