A three-year survey shows that although consumer-driven and high deductible health plans increased in 2007, they still only make up a small segment of the overall insurance market.
Plan enrollees also report there have been no significant gains in the provision of information of provider cost and quality by health plans.
The EBRI/Commonwealth Fund Consumerism in Health Care Survey polled 4,217 privately insured adults ages 21-64 online during August and October of 2007.
In 2001 CDHPs were introduced to decrease the number of uninsured, encourage cost-consciousness among consumers and increase the amount of information on the cost and quality of providers. Claims have been made that the plans favor wealthy and healthy participants at the expense of those with lower incomes and poorer health status.
The survey found that in 2007 enrollment in consumer-driven plans with a tax-advantaged account was 2 percent, representing 2.3 million adults ages 21-64 with private insurance. This was up from 1 percent in 2005-2006.
Enrollment in HDHPs increased from 9 percent in 2005 to 11 percent, representing 12.5 million people, of which 5.2 million (42 percent) reported that they were eligible for a health savings account but did not have such an account.
Overall, 7.5 million surveyed were either in a CDHP or an HDHP that was eligible for an HSA, but had not opened the account. One in 10 insured adults had high-deductible health plans without accounts.
"Although consumer-driven plans have been around since 2001, market penetration is small," said Paul Fronstin of EBRI, lead author of the issue brief.
In 2005-2007 the survey revealed that adults who were enrolled in CDHPs became increasingly more likely to earn higher incomes (30 percent earning above $100,000), were in better health, were less likely to have chronic health conditions or to smoke and were more likely to exercise than people in more comprehensive health plans.
"These plans are not yet solving the problems they set out to address," said co-author Sara Collins of the Commonwealth Fund.
Those in CDHPs, however, were somewhat more satisfied with their plans in 2007 - even recommending them to friends. In 2005 and 2006, individuals in CDHPs and HDHPs were less satisfied with various aspects of their health plan than individuals in more comprehensive plans, the survey said.
Also, individuals in CDHPs and HDHPs reported using health services at rates similar to those in comprehensive plans, and there were no reported differences in the use of preventive screens or tests.
The survey found evidence that those in CDHPs and HDHPs are more likely to skimp on needed medical care or medications because of cost than those in more comprehensive plans.
Over 2005-2007, the reported rates of cost-related problems dropped among adults in CDHPs, although not among those in HDHPs.