Consumer-Driven Healthcare
Consumer-Driven Healthcare (CDHC) represents a shift in health insurance, emphasizing personal choice and financial responsibility. It combines high-deductible health plans (HDHPs) with tax-advantaged savings accounts, allowing individuals to manage their healthcare costs more directly. Under this model, policyholders are responsible for paying deductibles and co-payments using funds from their savings accounts or out-of-pocket, with the insurance covering costs thereafter.
CDHC emerged in the late 1990s and gained traction in the early 2000s as rising healthcare costs prompted employers to seek affordable options. The approach gained further momentum with the implementation of the Affordable Care Act in 2010, which led many employers to adopt CDHC to provide adequate health coverage at lower premiums. Key components of CDHC include Health Savings Accounts (HSAs), Medical Savings Accounts (MSAs), Health Reimbursement Arrangements (HRAs), and Flexible Spending Accounts (FSAs), each offering different funding and rollover options.
While CDHC encourages consumers to be more cost-conscious and selective about their healthcare, it can pose challenges for lower-income individuals who may find high deductibles a barrier to accessing necessary medical care. As more people work part-time or freelance, the flexibility of CDHC plans appeals to those seeking tailored health solutions. However, debates continue regarding whether the advantages of CDHC truly outweigh its drawbacks, particularly for vulnerable populations.
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Consumer-Driven Healthcare
Consumer-driven health care (CDHC) is a form of health insurance that combines a tax-advantaged savings account with a high-deductible health insurance plan. The individual covers the deductible and any co-payments with money from the savings account or, if the account is insufficient, by paying out of pocket, with the health insurance plan covering all remaining costs. Traditionally, when an employee receives health insurance through work, the employer chooses the insurance provider and plan, and the employee had little or no input. In contrast, CDHC gives employees more control, enabling them to find a health care plan that fits their needs. In the twenty-first century, employers increasingly offered CDHC plans in order to reduce business expenses.
Background
The modern concept of individual or family health insurance plans, where individuals pay a certain monthly or annual premium, began to emerge in the late 1920s and early 1930s in the United States. Before that, although some companies offered their employees accident or disability insurance, Americans generally had to pay for their own health care.
The first employer-sponsored health care plan was established in 1929. In the early twentieth century, technological innovations such as x-ray machines and other medical advancements raised the cost of health care, and growing population density due to increased urbanization caused the demand for medical care to likewise grow. To curb these rising costs and reduce unnecessary hospital visits, a group of Dallas public-school teachers entered into an arrangement with Baylor Hospital (now Baylor University Medical Center at Dallas) in which they would pay a small monthly amount for access to medical care.
Soon, hospitals around the country followed suit, creating a broad system that continued to grow for decades. However, over those decades, the cost of health care grew at a rate that outpaced inflation. The Medicare and Medicaid programs were established in 1965, and several other efforts were made to reform the system in the 1970s. Despite these attempts, it was not until the late 1990s and early 2000s that a radical new option was introduced—namely, customer-driven health care.
CDHC plans began to emerge in the late 1990s. Demand increased in the early 2000s due to companies’ rising health care costs and the growing use of the internet as a tool for consumer information sharing. CDHC experienced a new surge in popularity in the 2010s due to the Patient Protection and Affordable Care Act (PPACA), or Affordable Care Act (ACA) for short, enacted by the US Congress in 2010 with the goal of providing greater health security for all Americans. The ACA introduced new regulations for insurance companies and mandated that all companies with more than fifty employees offer health insurance to full-time workers.
In order to comply with the ACA by providing employees with adequate health benefits, more companies began turning to CDHC as an affordable alternative. Employers began to move away from expensive plans with high premiums and low deductibles in favor of low-premium, high-deductible CDHC plans. Companies also began offering incentives for employees to look for cost-effective health plans.
Overview
An employer who offers a CDHC plan will often allow employees to select a high-deductible health plan (HDHP) from a range of options. In 2023, about 27 percent of consumers were enrolled in a HDHP, according to the Employee Benefit Research Institute (EBRI). Of those, 18 percent were enrolled in consumer-driven plans. HDHPs have much lower premiums (the monthly or annual fees required to participate) than traditional health plans, in exchange for much higher deductibles (the portion of health care costs that the individual must pay before the insurance company will cover expenses). The plan may cover just the employee, or it may cover the employee’s family as well. The employer will also provide the employee with a tax-advantaged health savings or spending account, which may be funded by the employer, the employee, or both, depending on the type of account.
A tax-advantaged account is an account in which a person can deposit a portion of their income prior to any withholding of tax. This money can then be used to pay for qualifying expenses without penalty. There are four different types of tax-advantaged accounts associated with CDHC: health savings accounts (HSAs), medical savings accounts (MSAs), health reimbursement arrangements (HRAs), and flexible spending accounts (FSAs).
An HSA may be funded by either the employer or the employee. The Internal Revenue Service (IRS) limits the amount of money that can be deposited each year, but any unused funds in the account can be rolled over to the next year, and HSA funds remain with the employee if they leave their job. An HSA can only be opened if the account holder is enrolled in an HDHP that meets the standards set by the IRS. The money in the account may be invested, and no tax is levied as long as funds are only withdrawn to pay for medical expenses.
An MSA, also called an Archer MSA, also must be combined with a qualified HDHP. Its regulations for the associated HDHP are much stricter, including annual limits on deductibles and out-of-pocket expenses. MSAs are largely obsolete, as the legislation that enabled them lapsed in 2007. Current MSAs may be maintained, but no new accounts may be opened.
An HRA must be funded exclusively by the employer. An individual does not need to be enrolled in a HDHP to participate. The funds in an HRA cannot be invested. As with the HSA, any unused funds will roll over from one year to the next.
An FSA also does not require the account holder to be enrolled in an HDHP. Both the employer and the employee may fund the account. The employee’s contribution is taken from his or her wages before tax. FSAs are the only CDHC-associated accounts that do not allow funds to be rolled over to the next year; any funds not used before the end of the year are lost.
CDHC plans have both advantages and drawbacks compared to traditional insurance plans. Experts are divided on whether the plans truly provide health benefits to employees. One advantage of CDHC is that once the annual out-of-pocket maximum is met, the insurance plan will cover all costs for the remainder of the year, with no coverage cap. This makes them ideal for severe or catastrophic medical expenses, such as unforeseen diseases or sudden tragic accidents.
Another stated advantage of a CDHC plan is that the high deductible will reduce unnecessary doctor and hospital visits and drive consumers to seek more cost-effective options. The 2022 Consumer Engagement in Health Care Survey, administered by the EBRI and Greenwald Research, found that those who are enrolled in CDHC plans tend to be more cost-conscious and ask their doctors about medical alternatives and options than those with comprehensive plans. However, for lower-income individuals, the higher deductible often has the effect of preventing them from seeking necessary medical care as well. The survey also reported that individuals in higher income brackets are more willing to enroll in CDHC plans than those in lower income brackets, who are more likely to sacrifice medical services in order to have money to pay other bills, and that enrollees of CDHC plans tend to be older than those who enroll in traditional health plans.
One reason for the growing popularity of CDHC is the increase in the number of people who have multiple part-time jobs, are self-employed, or work as freelancers. Part-time employees generally are not offered health insurance by their employers, and those who work for themselves must purchase their own health insurance. Many individuals also prefer having the ability to save money by selecting the health benefits that best suit their needs. However, more research is necessary to determine whether the advantages of CDHC plans truly outweigh the drawbacks.
Bibliography
Carr, David F. "What Consumer-Driven Healthcare Really Means." InformationWeek. UBM Tech, 31 Jan. 2014. Web. 27 Aug. 2015.
Cohn, Jonathan. "The Danger of Consumer-Driven Health Care." New Republic. New Republic, 7 Nov. 2005. Web. 27 Aug. 2015.
"Fast Facts: Enrollment in High-Deductible Health Plans and Consumer-Driven Health Plans Remains Steady—Most Traditional Plan Enrollees Still Not Familiar With Them ." EBRI, 9 Mar. 2023, www.ebri.org/docs/default-source/fast-facts-(public)/ff-456-cehcs3-9mar23.pdf. Accessed 13 Dec. 2024.
Feldstein, Paul J. Health Policy Issues: An Economic Perspective. 5th ed. Chicago: Health Administration, 2011. Print.
Herzlinger, Regina E. Consumer-Driven Health Care: Implications for Providers, Payers, and Policymakers. San Francisco: Jossey, 2004. Print.
Howard, Paul. "Obamacare Is Killing Traditional Employer-Sponsored Health Insurance." Apothecary. Forbes.com, 23 Sept. 2013. Web. 27 Aug. 2015.
Jost, Timothy Stoltzfus. Health Care at Risk: A Critique of the Consumer-Driven Movement. Durham: Duke UP, 2007. Print.
Kotler, Philip, Joel Shalowitz, and Robert J. Stevens. Strategic Marketing for Health Care Organizations: Building a Customer-Driven Health System. San Francisco: Jossey, 2008. Print.
Martin, Erik, and Les Masterson. "High Deductible Health Plans: Your Complete Guide to HDHPs." Forbes, 7 Sept. 2022, www.forbes.com/advisor/health-insurance/high-deductible-health-plan/. Accessed 13 Dec. 2024.
Orchard, Chris. "8 Challenges to Customer-Driven Health Care." Harvard T. H. Chan School of Public Health. Harvard Coll., 2015. Web. 5 Aug. 2015.
"2023 Consumer Engagement Health Care Survey." Employee Benefit Research Institute,www.ebri.org/docs/default-source/cehcs/2023-cehcs-report.pdf. Accessed 13 Dec. 2024.
Yi, Song G. "Consumer-Driven Health Care: What Is It, and What Does It Mean for Employees and Employers?" Compensation and Working Conditions Oct. 2010: n. pag. Bureau of Labor Statistics. Web. 27 Aug. 2015.