Consumer and Provider Costs

Consumer and Provider Costs​

Over the last 20 years, Consumer-directed health plans (CDHP) have become one of the most popularly adopted health insurances amongst the United States working class. Due to the steady increase in healthcare costs amongst both employers and employees within larger companies, CDHP allows decreased premiums with higher deductibles and increased cost sharing. Customary health insurance plans (HMO, DMO, PPO) ensure low co-payments and cost sharing but significantly higher premiums which means higher expense for employers. The idea of CDHP becoming the standard and being offered by many employers is to encourage employees to obtain and seek medical services in a cost-efficient way. People with consumer-directed health plans are expected to be accountable and conscious of their own health spending. CDHP’s have given consumers freedom when it comes to his or her own health. “The freedom of choice theme represents a further opportunity for more complete commodification of health care and the potential for further segmentation in health care markets as previous market-based reforms have done” (Bownds, 2003, p. 427). The problem with this idea is that many employees within the millennial generation having to obtain their own health insurance plans at 26 are not well-educated on how expensive medical services actually are. More often than not, millennials will only go the extent of making sure the medical practices they use are in network with their insurance without taking into consideration the cost of their services in comparison to other medical practices that may also accept their insurance. I state this confidently, because I myself, am a millennial.

Millennials affected by Consumer-Driven Health Plans​

Becoming a dental hygienist was my life-long dream. When I passed a prestigious dental hygiene program, all my national and state board exams, and became licensed, I was ready to begin my life-long career. I quickly began temping in many private practice offices figuring out what I truly wanted to see in an office (technology, quality care, proper sterilization techniques, etc.) and what I absolutely did not want to witness. When I found a full-time position in a private office consisting of one doctor, and four other employees other than myself, I thought it was the perfect fit. And it was, for a while. The office was a little outdated with the use of paper charting and the technology wasn’t entirely up to speed. It was perfect for me to gain experience and truly begin my journey as a dental hygienist. The doctor, who was also my employer, offered a great starting salary with absolutely no benefits (health insurance, vacation time, 401k, or paid holidays). As one could imagine, the lack of benefits made my job less and less appealing every single day.

I became comfortable quickly. Although I loved where I worked, who I worked with, and every single one of my patients I treated, my 26thbirthday was approaching quicker than I thought. This only meant one thing. I not only was approaching my “late” twenties, but I would no longer have healthcare insurance. I had to make one of the more difficult decisions as an oral health care provider. Quality of patient care or Quality of my own life. There are two types of dental practices. A hygienist upon licensure could choose to work for; a private or corporate dental office. Private dental offices usually house one doctor, one to two hygienists and anywhere from five to six employees. On the other hand, a corporate dental office can hold up to five doctors, five hygienists, and up to 30 employees in just one office. The main differences between the two is the quality of care, the responsibility levels of a provider such as a doctor or dental hygienist, and benefits. Most dentists owning a private practice do not offer benefits to their employees because it’s simply unaffordable while corporate dental offices have the capital to do so. The Harvard Business Review conducted a study to determine what benefits employees want from their employers the most. It was a tie for better health, dental and vision insurance with flexible hours(Jones, 2017). It was stated by many participants that the health, dental, and vision benefits were highly relied on when choosing a job(Jones, 2017).

I quickly realized the inevitable. According to Sigismondo (2019)“It would be extremely difficult for me to find a privately-owned dental office that would offer me the benefits to make dental hygiene into a lifelong career as I always dreamed” (p. 4). However, I needed to find a corporate office that would still allow me to treat my patients with the highest quality of individualized oral healthcare. I did just that. I got hired by a corporate company masked as a privately-owned dental office that would allow me to individualized patient care and treat them with even better care than I did in private practice. This position also matched my salary from my previous job as well as offering to pay 200$ a month towards my health insurance premium, two weeks paid vacation, one week of sick time, holiday pay, and 401K. It’s safe to say I was a millennial living the dream. It came time to sign up for their offered health insurance and I was shocked. It was a consumer-direct healthcare plan that had a significantly lower premium and a very high deductible. They offered three separate plans, a low plan, middle plan, and high plan to choose from. Each of these plans all held about the same deductible of 2000$, high co-pays, with significantly different premium costs. The co-pays for visits I have needed thus far were not necessarily as “low” as my insurance, but affordable. It wasn’t long until I realized how my employer could afford to offer health insurance to all of his employees.

Since obtaining this plan through my employer, I have been doing my best to stay up to date on all my yearly check-ups and blood tests. It is important that people who obtain the CDHP’s understand their benefits in knowing that these services are not subject to the deductible(Fronstin, 2010). Without this knowledge, it could impact the use of those services, which is the complete opposite of where consumer focus should be(Fronstin, 2010). Preventative healthcare is paving the way to help patients prevent inevitable genetic diseases such as high blood pressure, diabetes, high cholesterol, etc. Health insurances regardless of the plan are more inclined to ensure those with s preventative mindset.

Conclusion
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Having health insurance is better than not having any at all in cases of medical emergencies regardless of the plan. Knowing that the co-pays and deductibles are characteristically extremely high with CDHP’s, it will encourage its’ subscribers to seek preventative healthcare to avoid serious medical issues. It is important that people learn about the health insurance plan that insures them, including information about their deductible, what is covered, and what is not covered.



References

Bownds, L. (2003, June). Consumer-driven health plans: more choice is not always

better. Journal of Economic Issues, 37(2), 425-432. Retrieved from Consumer-Driven Health Plans: More Choice Is Not Always Better on JSTOR

Fronstin, P. (2010, August). What do we really know about consumer-driven health plans?. Employee Benefit Research Institute, 325(), 1-27. Retrieved from http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=3&sid=508731ab-223e-44fe-8ddc-7d4fd21a63af%40sessionmgr4006

Jones, K. (2017, February). The most desirable employee benefits. Harvard Business Review, ().

Sigismondo, S. M. (2019, Summer). Consumer and provider costs.