RESEARCH OBJECTIVE: Many health policy researchers have argued that increased health insurance plan choice will enhance the efficiency of health care markets by improving competition. However, relatively little is known about the prevalence of choice in the workplace or its effects on access to and satisfaction with coverage. This paper examines the availability of health insurance plan choice in the U.S. workplace and determines the extent to which individual workers have access to additional health insurance plans indirectly through a family member's (usually a spouse) job. Additionally, we examine the distribution of choice availability across the population and investigate the relationship between health insurance plan choice and several measures of plan satisfaction and access.

STUDY DESIGN: We use data from Rounds 1 and 2 of the 1996 Medical Expenditure Panel Survey (MEPS). The MEPS collects data on health care use and expenditures, insurance and health plan satisfaction, and sources of payment, along with basic demographic information, for a nationally representative sample of the United States civilian noninstitutionalized population. Our sample consists of workers between the ages of twenty-one and sixty-four who are employed but not self-employed and who were offered health insurance (workers were included in the analysis regardless of whether they held or were covered by employment-based health insurance). The main variables of interest for our analyses are 1) whether a worker was offered more than one main health insurance plan; and 2) whether a worker had access to more than one health insurance plan from his own job or the job of a family member. We use univariate and multivariate analysis to determine the importance of sociodemographic, employment, and geographic characteristics on the likelihood that a worker has a choice of health plans. Multivariate analyses are also used to assess the importance of plan choice on satisfaction with care.

PRINCIPAL FINDINGS: Preliminary results show that many workers do not have a choice of health plans and that having a choice of health plans is associated with higher satisfaction and greater access to health care. While accounting for spousal and other family coverage increases the number of workers with plan choice, there remains a sizable proportion of workers who lack health insurance (in the absence of changing jobs). Finally, health insurance plan choice appears to be correlated with worker, employment, and geographic characteristics.

CONCLUSIONS: Our intitial findings show that a large number of employees are offered only one health plan from their employer. Additionally, those without choice are less satisfied with their health insurance coverage and are less likely to have access to care.

IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: One of the major tenets of the theory of managed competition is that the efficiency of the U.S. market would be largely improved if all employees had a choice of health plans. If this is true, there is considerable room for improvement since many employees lack such choice. This finding is vitally important to those concerned with the efficiency of the U.S. health insurance market.

Publication Types:

• Meeting Abstracts

Keywords:

• Choice Behavior
• Data Collection
• Employment
• Health Care Sector
• Health Policy
• Insurance Coverage
• Insurance, Health
• United States
• Workplace
• economics
• hsrmtgs

From Meeting Abstracts Abstr Book Assoc Health Serv Res Meet. 1999; 16: 190.