Abstract
Background: Many employers are offering their employees choices of health insurance plans that differ in their upfront costs, e.g., lower monthly employee premiums, and in the amount of patient cost-sharing, e.g., deductibles for the first dollar of care. In a group of employees who had a choice of traditional plan (no deductible) or deductible plan in 2006, we examined characteristics associated with choosing the deductible plan.
Methods: All subjects were primary subscribers in a large integrated health delivery system with a choice of traditional and deductible health plans. We used logistic regression to examine the characteristics associated with the choice of deductible plan and explored interactions between characteristics. Subscriber characteristics include enrolling any children (age <18 years) or elderly (65 years or older) on their plan, enrolling any chronic disease patients with asthma, diabetes, coronary artery disease, hypertension, or heart failure on their plan, neighborhood (census block group) education and income. There were 5 levels for neighborhood education: =20%, =15%, =10%, =5% or <5% of adults had less than a high school education, and 6 levels for neighborhood income: median household income <150%, <200%, <300%, <400%, <500% or =500% of the federal poverty level.
Results: Among the 29,701 primary plan subscribers, 21% chose a deductible plan, 30% of the subscribers had children or elderly on their plan, and 38% had a chronic disease patient on their plan. Characteristics associated with choosing a deductible plan included not enrolling children or elderly on their plan (OR=1.32, 95% CI: 1.23–1.41), having no chronic patient on their plan (OR=1.61, 95% CI: 1.33–1.96), living in neighborhoods with higher education (OR=1.16 for each level increase in education, 95% CI: 1.13–1.18), living in neighborhoods with higher median income (OR=1.19 for each level increase in income among subscribers having no chronic patient on the plan, 95% CI: 1.15–1.23; OR=1.13 for each level increase in income among subscribers having chronic patients on the plan, 95% CI: 1.08–1.19).
Conclusions: One in five employees with the choice of a deductible health insurance plan chose the deductible-based plan. Employees without children or elderly on their plan, who lived in neighborhoods with higher educational attainment and higher median household incomes, and who had no one with a chronic condition on their plan were more likely to choose a deductible plan.
- Received September 11, 2008.
