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Do consumers know how their health plan works?
P J Cunningham1, C Denk, M Sinclair
1Center for Studying Health System Change, Washington, D.C., USA.
Health Affairs (Project Hope)
|March 23, 2001
Summary
Informed health insurance choices are key. Many consumers inaccurately recall plan details, often overstating provider restrictions, impacting their ability to choose the best health plan.
Area of Science:
- Health Services Research
- Consumer Behavior
- Health Insurance Policy
Background:
- Consumer choice in health plans is increasing.
- Informed decision-making is crucial for maximizing the benefits of plan choice.
- Understanding consumer knowledge of health plan attributes is essential for policy and practice.
Purpose of the Study:
- To compare consumer recall of health plan attributes with actual plan information.
- To assess the accuracy of consumer understanding regarding provider choice and specialist access.
- To identify patterns in consumer reporting of health plan restrictions.
Main Methods:
- Utilized data from the 1996-97 Community Tracking Study (CTS).
- Compared consumer self-reported data on four key health plan attributes against plan-provided information.
- Focused on attributes related to provider networks and specialist access.
Main Results:
- While accuracy varied for individual attributes, less than one-third of consumers accurately reported all four attributes.
- Consumers generally tended to overreport limitations imposed by their health plans.
- A notable tendency was observed in overstating the requirement for prior authorization to see specialists.
Conclusions:
- Consumer knowledge of health plan details is often limited, potentially hindering informed choices.
- The tendency to overreport restrictions may lead to unnecessary avoidance of certain plans or services.
- Interventions to improve consumer understanding of health plan features, particularly access rules, are warranted.