Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

3 million Californians use health plans with high out-of-pocket costs

29.10.2010
Costs may cause members to delay care, put families in financial jeopardy

Three million Californians are enrolled in high-deductible health plans, insurance policies that offer consumers a lower monthly premium in return for higher out-of-pocket spending for health care services, according to a new report from the UCLA Center for Health Policy Research.

These health plans, which can impose deductibles of more than $5,000, may cause members to delay care and can put families in financial jeopardy should a health crisis arise, say the authors of the report, "Profiling California's Health Plan Enrollees: Findings from the 2007 California Health Interview Survey." Yet high-deductible plans are often the only insurance many Americans — especially the self-employed and those with low-incomes — can afford.

The report, which profiles California's nearly 32 million insured residents, found that a total of 3 million commercially insured Californians were enrolled in high-deductible plans in 2007. Enrollment in high-deductible health plans is particularly high among members of preferred provider organizations (PPOs) — 28 percent of all commercial PPO members reported having a deductible higher than $1,000. Among commercial health maintenance organization (HMO) plan members, 14 percent reported having such plans.

High-deductible plans, defined by the California Health Interview Survey as those that have out-of-pocket deductibles of $1,000 or more for individuals or $2,000 or more for families, can exceed $5,000 annually.

"Many Californians can't afford higher-premium plans, especially in the current economic climate," said the report's lead author, Dylan Roby, a research scientist with the UCLA Center for Health Policy Research. "But the alternative — high-deductible plans — may cost less initially but can cost thousands of dollars when you need health care. When that much money is on the line, a health emergency can also become a financial emergency."

The findings have significance as the state establishes the new California Health Benefits Exchange to provide insurance to the state's uninsured as part of national health care reform. Per the federal law, this exchange will offer more robust health coverage options while capping out-of-pocket deductibles at $2,000 for individuals and $4,000 for families and offering subsidies for those with low-incomes.

"The insurance exchanges may offer a lifeline to individuals and families by establishing reasonable out-of-pocket maximums for families to pay," Roby said.

Lowering deductibles is especially important for California's low-income residents, as well as individuals not insured through an employer. Both groups have historically had less access to affordable coverage.

The report found that significant numbers of low-income Californians were likely to choose high-deductible health plans. Specifically, nearly one-third (32 percent) of low-income enrollees in commercial PPOs had such plans. One-fourth (25 percent) of low-income commercial HMO enrollees and 24 percent of commercial Kaiser HMO enrollees also reported choosing high-deductible plans.

Among the individually insured (those who purchase commercial insurance directly through brokers, HMOs or PPOs), 38 percent had high-deductible plans, compared with 12 percent of those with employer-based plans.

High out-of-pocket costs are associated with a reluctance to seek care. For example, commercial PPO enrollees with high-deductible plans were significantly more likely to delay care (20 percent) than those without high deductibles (17 percent).

And the vast majority of members in high-deductible health plans had no health savings account that might help mitigate the cost of unanticipated health care. Among commercially insured respondents with a high-deductible plan, 69 percent of PPO members, 77 percent of HMO members and 80 percent of Kaiser HMO members reported having no health savings account for medical expenses.

The findings demonstrate the need for expanded educational efforts to ensure that consumers understand the costs and consequences of health insurance choices, the authors said.

"Consumers need information to choose the right coverage so they receive the care when needed, not just when they can afford it," said Sandra Perez, director of the California Office of the Patient Advocate. "Thus, it is essential that a consumer have acces to reliable information and helpful decision-making tools to make an informed choice when selecting a health insurance plan."

To assist consumers, the Office of the Patient Advocate provides cost worksheets and other related information on its website.

The report provides a detailed look at the enrollment, characteristics, disease conditions, health status, health care use and barriers to care among members of private and public health plans in California.

Among the findings:

High HMO enrollment
California remains the leader in HMO enrollment in the nation, with approximately half of all Californians enrolled in an HMO, compared with 21 percent nationally.
Shift to PPOs in commercial market
The proportion of individuals who reported enrollment in commercial PPO plans rose from 26 percent in 2003 to nearly 28 percent in 2007, an estimated increase of 1.2 million Californians (from 7.6 to 8.8 million). By comparison, the proportion of insured Californians who reported enrollment in commercial HMO plans decreased slightly, from 42 percent to 40 percent.
Increase in Medi-Cal–managed care enrollment
Medi-Cal HMO enrollment increased by 245,000 to 2.4 million Californians in 2007, driven by the movement of Medicare and Medi-Cal enrollees into managed care.
Mental health
Over 15 percent of all adults in health plans reported experiencing serious psychological distress in the past year; lost productivity from mental health issues is prevalent, especially among the publicly insured. The cost of treatment was cited as a barrier to mental health treatment for more than 30 percent of adults in health plans.

Read the full report: "Profiling California's Health Plan Enrollees: Findings from the 2007 California Health Interview Survey."

The California Office of the Patient Advocate is an independent state office established to inform and educate consumers about their rights and responsibilities as health plan enrollees and to teach them how to make best use of the services offered by their health plans.

The California Health Interview Survey is the nation's largest state health survey and one of the largest health surveys in the United States.

The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health-related information on Californians.

For more news, visit the UCLA Newsroom and follow us on Twitter.

Gwen Driscoll | EurekAlert!
Further information:
http://www.ucla.edu

More articles from Business and Finance:

nachricht Europe's microtechnology industry is attuned to growth
10.03.2017 | IVAM Fachverband für Mikrotechnik

nachricht Preferential trade agreements enhance global trade at the expense of its resilience
17.02.2017 | International Institute for Applied Systems Analysis (IIASA)

All articles from Business and Finance >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

Im Focus: Researchers Imitate Molecular Crowding in Cells

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

When Air is in Short Supply - Shedding light on plant stress reactions when oxygen runs short

23.03.2017 | Life Sciences

Researchers use light to remotely control curvature of plastics

23.03.2017 | Power and Electrical Engineering

Sea ice extent sinks to record lows at both poles

23.03.2017 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>