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Americans prefer employer-selected health coverage

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Americans would much rather choose a health plan from a set of options offered by their employers than be given an employer-funded account to purchase their own plan, according to a new study.

Two-thirds of the adults surveyed in the study, released on Sept. 22 by the Commonwealth Fund, preferred having employers choose health-plan options, with majorities of both Democrats and Republicans supporting that approach.

The study also revealed that people care more about being able to choose their own doctors than about having a choice of health plans.

"What we're finding is that, whatever way you cut it, it looks like the type of choices that people prefer are about health-care providers, not about health-care plans," says study author Jeanne M. Lambrew, an associate professor of health policy at George Washington University in Washington, "and they're not so eager to abandon the employer-based system."

The findings call into question whether policymakers ought to be pushing health-savings accounts, or HSAs, as a way to reduce health costs and give people more control over how they spend their health-care dollars. Lambrew's analysis suggests that it may not be what most people want.

"We saw a public backlash against very closed HMOs in the 1990s," she says. "We may see a similar backlash against these types of policies, given the fact that people may not want them and that they prefer a type of system in which we still have employers involved in making these decisions."

Greg Scandlen, founder of a newly formed lobbying organization called Consumers for Health Care Choices, argues that this interpretation is flawed.

"This is looking at things the way politicians look at things," he says. "They're looking for 50-plus-percent support of an idea, which is not the way markets work."

This survey found that one-third of the responders preferred to choose their own health plans, he adds, "and one-third of the market is huge."

Currently more than 1 million Americans receive health care through a high-deductible plan paired with a health-savings account, according to a study by America's Health Insurance Plans.

An HSA is a relatively new type of investment account that gives people a tax-free way to save for medical expenses. Contributions to the HSA may be carried over from year to year to pay for future medical care, or the account holder may withdraw funds as needed to cover current expenses, including doctor and hospital bills, prescription drugs and over-the-counter medications.

President George W. Bush has endorsed HSAs as a way of reining in the rising cost of health care in the United States, but critics of this approach worry that it will erode the current employer-based system of health insurance.

Using data from the Commonwealth Fund's own biennial health-insurance survey, Lambrew examined whether people really want more choice and control over their health-plan options, as HSA proponents insist. The survey utilizes data from a nationally representative sample of 3,293 working-age adults.

The data suggest that people value provider choice more highly than health-plan choice. Only about 12 percent of those with only one health plan, in other words having no other choice of plan, were likely to be dissatisfied with their health care. On the other hand the dissatisfaction rate was more than twice as great -- 26 percent -- among those individuals given no choice as to which provider to go to for their care.

Additionally, 67 percent of people who had no choice of where to go for their care indicated that a choice of health plans is very important, compared with only 55 percent of those whose plans offered plenty of provider choices. In contrast, only 37 percent of people restricted to one choice of health plan deemed having multiple health-plan choices as very important.

"So, ironically, the people with no choice of plan didn't really feel like it was a problem," Lambrew says. "But the people who have very limited choice of doctors did feel like, if they could just have more choices, they could get out of this box."

Based on these new findings, Lambrew urges policymakers to think twice about moving away from the traditional employer-based system.

Scandlen, however, doesn't think that policymakers should bet on any single approach.

"I don't think that everyone should be in an HSA plan," he says. "Some people prefer HMOs, and they should be able to do that too."

(The HealthDay Web site is at

c.2005 HealthDay News

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