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Consumer health plans divide risk pool

Posted - Sep. 1, 2004 at 2:40 p.m.



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OAKLAND, Calif., Sep 01, 2004 (United Press International via COMTEX) -- Consumer directed health plans divide the risk pool, which could hurt U.S. employer-sponsored group insurance, a Kaiser study said Wednesday.

Consumer directed plans -- high-deductible catastrophic plans accompanied with a savings or spending account -- are gaining in popularity because they are less expensive.

Traditional group plan premiums are lower because risk is spread among the healthy, sick, young and old -- the healthy, in effect, subsidize care for the sick. If healthy people choice consumer directed plans, the group plan is left with more sick people -- raising healthcare costs and premiums.

The Kaiser Permanente study, published in a special edition of the journal Health Services Research devoted entirely to early experiences with consumer directed healthcare, found considering age, gender and demographic data, those enrolling in these plans did not appear to be healthier than those remaining in group plans.

Digging deeper into more sophisticated data -- prior use of health services, health spending and pharmacy usage -- people in the consumer directed plans were 25 percent to 50 percent healthier, researchers said.

The authors said unless risk adjustment takes place, such segmentation of the risk pool could result in a "death spiral" for the other group plans.

Copyright 2004 by United Press International.

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