Interview: Greg Scandlen, Consumers for Health Care Choices
The Commonwealth fund recently came out with a report that was based on an online survey that, according to Greg Scandlen, founder of Consumers for Health Care Choices, was not very accurate. The Commonwealth Fund and EBRI surveyed about 3,000 people and found 28 people who had Consumer Driven Health Plans and concluded that there are only about 1 million people who have CDHPs nationwide.
According to Greg, the vendors, health insurance companies, employers, and HSA administrators who have counted, have said that a little over 13 million people have CDHPs, or 10% of the benefits market. That a survey could be that far off suggests that the rest of the findings in the survey cannot be that accurate.
Greg Scandlen started Consumers for Health Care Choices because too many health care conferences and industry organizations are focused on the interests of the insurance companies, the technology vendors, etc. Everyone is a health care consumer and the goal of Consumers for Health Care Choices is to represent the voice of the consumer.
Greg was the chair of the Consumer Directed Health Care Conference consumer awareness track called How Consumers Can Cope in a Consumer-Driven World.
Greg Scandlen’s characterization of the 2006 EBRI/Commonwealth Fund Consumerism in Health Care Survey is inaccurate. Furthermore, Greg apparently has a double standard for what passes as methodologically sound research.
Greg states that the biggest problem with the EBRI/Commonwealth survey is that it is an on-line survey. In Consumer Power Report (CPR) #58 (http://www.chcchoices.org/publications/CPR%20–%2058.pdf) Greg recently described a study on public opinion of consumer-driven health plans conducted by the Kaiser Family Foundation as follows: “The first question of any survey is how representative is it of reality. This one seems to be pretty solid, though still with some flaws.”
Like the EBRI/Commonwealth Fund survey, the Kaiser Family Foundation Survey is an online survey. (More information about the Kaiser survey can be found at http://www.kff.org/kaiserpolls/pomr112906pkg.cfm). Similarly, Last year when critiquing the 2005 EBRI/Commonwealth survey Greg mentioned a BlueCross Blue Shield (BCBS) study. In CPR #15 (http://www.chcchoices.org/publications/CPR%20–%2015.pdf), Greg wrote the following: “For instance, both the McKinsey Report and the Blue Cross Blue Shield study completely contradict these findings with much more powerful and robust survey methods.” Again, like the EBRI/Commonwealth Fund survey, the BCBS study used an on-line survey.
Greg states that the EBRI/Commonwealth Fund survey we only found 28 people with a CDHP out of about 3,000. The EBRI/Commonwealth Fund survey found that there were only 28 people with an HSA or HRA out of a nationally representative sample of 1,631. This does in fact represent 1.3% of the adult population. The EBRI/Commonwealth Fund survey also found 7% of the adult population was in a health plan with a deductible high enough to qualify for contributions to an HSA.
Further analysis of this group determined that 31% were offered an HSA, 63% were not offered or aware of the option and 5% did not know about the option. This sample was used only to derive incidence estimates for individuals with an HRA or HSA, and for those eligible for an HSA.
We estimate the following:
• 1.3 million adults have an HSA or HRA
• 2.6 million adults know that they were eligible for an HSA (others may be eligible but don’t know)
The bottom line is that we estimate 3.9 million adults either have an HRA or HSA, or are eligible to contribute to an HSA.
Steve Davis, editor of Inside Consumer-Directed Care, compiles and publishes the most reliable enrollment estimates. From his publications dated 11/24/06 and 8/11/06 you will find that out of the health plans representing 153 million people, 4.6 million are either in an HRA or HSA, or are eligible to contribute to an HSA. When you impute the number for the full 180 million people or so with private insurance in 2006, you get about 5.4 million either in an HRA or HSA, or eligible to contribute to an HSA.
Why the difference between the EBRI/Commonwealth 3.9 million number, and the 5.4 ICDC number? Children. Our survey did not interview children. There is also a margin of error around both numbers, but the fact is our enrollment numbers are in line with where the market was in September 2006.
In terms of what the vendors are finding, Greg is misleading you or he doesn’t know what year it is. His estimate of 13.4 million is an estimate for where the market is today - 2007. It is an estimate, 2007 data is not yet available. The estimate assumes the market size doubled from last year. That’s a strong assumption. The EBRI/Commonwealth Fund survey was conducted in September 2006 so our estimates reflect 2006, not 2007.
For the remainder of our study we did in fact have to oversample the population with an HRA or HSA. We also oversampled the population eligible to contribute to an HSA. Overall, we interviewed 3,158 adults, and that sample includes 1) 722 people who either had an HSA or HRA, and 2) 930 individuals who had a deductible high enough to qualify to make a contribution to an HSA.
In cases of surveying a population with a small incidence, there is consensus in the survey profession that oversampling is the most accurate approach.
Let me just add that Greg likes to characterize the survey as the Commonwealth survey. The study is an EBRI/Commonwealth Fund collaboration with funding not only from the Commonwealth Fund but from companies like IBM, Pfizer, Procter and Gamble, and Hewitt Associates. It also has the support of the EBRI Board of Trustees, which includes Aetna, Cigna, Unitedhealth Care, BCBS, Kaiser, and other organizations.
More information about EBRI can be found at http://www.ebri.org.
A list of EBRI members can be found at http://www.ebri.org/about/members/.
More information about the EBRI/Commonwealth Fund survey can be found at http://www.ebri.org/surveys/chcs/.
I am a refugee from Canada. I left there because my wife waited 2.5 years on a surgical waiting list and eventually became crippled. I have been designing effective health plans for 12 years, and am an active speaker against universal and singel payer healthcare