Does the New Health Care Shape Up?

According to our readers, plans that require employees to be more responsible for keeping costs low may run into resistance

As employers move to so-called defined-contribution health care plans -- which provide a set amount each year from which employees must pay for all treatments except those for catastrophic illnesses -- chances are good that unhappiness at work will rise.

That's one conclusion to be drawn from the answers of the 600-plus people who responded to our May 9 Reader Survey.

For example, nearly 52% of the respondents to this unscientific survey said they oppose defined-contribution plans, vs. the 38% who say they favor them. Some 57% of those who replied said that defined-contribution health plans would prompt them to use cheaper generic drugs, while 38% said they wouldn't.

When it comes to choosing doctors and hospitals, however, the people who replied to our survey seemed to challenge the assumption of some health-care consultants that if patients have to spend more of their own money, they'll choose lower-cost care.

For instance, 77% of those who replied said they wouldn't be more likely, with such plans, to use the lowest-price physician, while 73% said they wouldn't choose the lowest-price hospital. Some 57% said they wouldn't shop on cost alone because of concerns that their quality of care would fall, while 26% said they would simply prefer to stick with their current health-care providers.

Incidentally, some 51% of those who responded fear that the quality of health care will decline under a defined-contribution system, while about 21% each felt that quality of care would either improve or stay the same.

Some 90% of those who replied think that if they're pushed to shop more on price, it's either extremely important or very important for them to have access to complete information on the past performance of specific doctors and hospitals. Some 36% think the federal government should provide such information, while 26% think that doctors and hospitals themselves should provide it.

Here are the complete results:

From what you know of defined-contribution health plans, do you:

Option Total %  
Favor them 229 38.29 %
Oppose them 309 51.67 %
Have no opinion 60 10.03 %

Do you think that with such a plan you would be more likely to buy generic rather than higher-priced brand-name drugs?

Option Total %  
Yes 339 56.59 %
No 214 35.73 %
Don't know 46 7.68 %

Would you be more likely to shop for the lowest-priced physician?

Option Total %  
Yes 94 15.72 %
No 459 76.76 %
Don't know 45 7.53 %

Would you be more likely to shop for the lowest-priced hospital?

Option Total %  
Yes 103 17.28 %
No 435 72.99 %
Don't know 58 9.73 %

If you wouldn't be more likely to shop for the lowest-price drug, doctor, or hospital, why not?

Option Total %  
Satisfaction with my existing medical care 155 26.54 %
Worry over the trade-off between cost and quality 334 57.2%
Convenient proximity of current health-care providers 28 4.79 %
Other 19 3.25 %
I would shop for the cheapest of all three 48 8.22 %

With defined-contribution health care, how important do you think it would be to have complete information on the past performance of specific doctors and hospitals?

Option Total %  
Extremely important 417 69.5 %
Very important 125 20.83 %
Important 43 7.17 %
Not very important 9 1.50 %
No opinion 6 1.00 %

Who should be responsible for providing this information and guaranteeing its accuracy?

Option Total %  
Employers 72 12.06 %
The federal government 212 35.51 %
Doctors and hospitals themselves 153 25.63 %
Other 74 12.4 %
Not sure 86 14.41 %

With defined-contribution health care plans, do you think the quality of health care in the U.S. will:

Option Total %  
Improve 130 21.74 %
Get worse 307 51.34 %
Stay the same 123 20.57 %
No opinion 38 6.35 %