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Related Experiment Videos

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
PubMed
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.

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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.

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