Monday, October 31, 2011

What Will Employees Accept to Lower Their Health Care Costs?

I recently looked at a Kaiser Family Foundation Public Opinion Survey that asked a random sample of people with employer insurance a number of questions about cost. The survey shows how far we have to go to come to grips with out-of-control health care costs.

The good news is that half have a reasonably accurate idea of the total cost of their health insurance. Their estimates were somewhat low, but in the ball park of reality.

The bad news is that the other half had no idea about a cost that was constraining their wages and cramping the employer they work for.

What dismayed me most were the responses to a list of possible changes to current insurance that would lower the cost of coverage. The only suggestion that received majority support (68%) was to "participate in a wellness program that promotes healthy behaviors such as losing weight or controlling your blood pressure or cholesterol." Only 30% were willing to accept paying more for brand name drugs, paying a higher deductible before the insurance kicks in, or accepting a more restricted list of participating doctors and hospitals.

So how are we going to keep health care costs from undermining public health more than is already happening?

Public education is important, but it won't do the heavy lifting. Despite lots of educational effort, something as obvious as constraining access to brand name drugs when alternatives are available still only gets 30% support.

Learning through experience is likelier to move our outlook. In the world of employer based insurance, employers and insurers should design multi-year approaches to helping us learn. We're starting to see employers offer "value-based" networks that emphasize primary care and community hospitals, with tertiary hospital care covered for services that aren't otherwise available. And as I've written about in previous posts, employers are putting more pressure on us to manage our health better (see here, here, and here).

In the current U.S. system, the majority of non-elderly with insurance get their health insurance through their employer. Employers and insurers should collaborate to make health insurance a "learning opportunity," not just a "fringe benefit." It takes us time to learn about financial responsibility in our growing up. It's going to take time and a similar concerted effort for us to learn health responsibility as adults!

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