If part of the goal of health care reform was to empower consumers to make better health insurance decisions, the reform movement may be failing a large portion of U.S. consumers.
After interviewing more than 500 health plan members who ostensibly have some input into plan selection, health care consulting firm Copatient reports 55 percent say they either had little control over their plan selection, or that the power resided with their employer, not them. And, of those, 37 percent say they had absolutely no control over their plan.
The study also found that 15 percent paid at least $5,000 in out-of-pocket expenses for health coverage last year, and 55 percent paid at least $1,000.
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"The financial model for healthcare is in the midst of a significant shift, which will require consumers to continue to pay for more of their healthcare out-of-pocket," says Thomas Torre, CEO of Copatient. "Our survey findings underscore just how important it is that consumers engage in healthcare decision-making and take control of their financial choices and obligations, moving forward. It is also incumbent upon employers to help their workforce navigate medical expenses and understand their health benefits and options."
And yet, control is exactly what very few consumers feel they have over health plan selection and expenses. In fact, the survey found, one in five respondents did not even know what type of health plan they were covered by. And a quarter didn't know when their enrollment period began.
Part of the problem may be that consumers continue to focus their cost containment efforts on premiums and co-pays, and not medical treatment costs. Half of those in the survey said they didn't research the cost of a medical procedure they were about to undergo. And most felt neither their plan administrators nor their employers were helpful in making critical decisions about the cost of coverage and treatment.
Contributing to the confusion around cost is the shifting clinical landscape in the medical profession. Many complained that they had been referred to a professional who was not in their plan; they didn't realize that had happened until the bill arrived in the mail.
"These survey findings highlight the growing need to empower consumers around health care finance management. The confusion is evident, as is the desire for help," says Torre.
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
