A recent Kaiser Family Foundation study revealed that nearly half of the 2,500 adults surveyed reported “some kind of problem with their health plan.”
The good news is that, for the vast majority of these individuals, the “problem” did not directly affect their health. Instead, they were frustrated with the “system,” or, as the study puts it, “more of a hassle than a horror story.”
Part of this frustration must be directly attributed to the lack of choices available to consumers. Most Americans under the age of 65 receive their health coverage through their employers. The majority of those employers are small to mid-size companies which generally offer only one “take it or leave it” health-plan package; employees have no say as to either their health plan carrier or their benefit level and they often are forced to dissolve long-standing relationships because their doctor of choice is not part of the participating network.
There is a related problem, as well. With employers paying the bulk of the healthcare premium, employees are sheltered from the true cost of their healthcare. This leads to little appreciation for what they are getting and no motivation to use healthcare resources wisely. What we have, therefore, are people joining health plans they haven’t chosen and receiving services whose value they are not equipped to judge. And we wonder why there is discontent?
Fortunately, a developing trend in healthcare today is the emergence of the “healthcare mall” approach to employer-sponsored health benefits.
In a healthcare mall, the employer sets a budget and defines the contribution it will make toward the employees’ health coverage. Employees then select from a wide range of competing health plans and varying benefit levels to find the one that best meets their individual family needs. Employers know that by providing choice they will have a more satisfied work force. Employees win because they are empowered to make their own decisions and have the flexibility to select benefits commensurate with their families’ needs and budget.
Is it better to have a plan with a lower deductible or lower co-pay? Can I find a plan that features all of my family’s doctors, specialists and choice of hospitals? Am I satisfied with my health plan or should I change? Only the individual should make those decisions.
Let’s put the consumer exactly where he or she belongs,squarely in the middle of the healthcare purchasing equation.
John M. Word III
(Word is managing partner of Orange-based CaliforniaChoice and a former president of the California Association of Health Underwriters.)
