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Employment and Health Benefits: A Connection at Risk (1993)

Chapter:A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES

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Suggested Citation:"A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES." Institute of Medicine. 1993. Employment and Health Benefits: A Connection at Risk. Washington, DC: The National Academies Press. doi: 10.17226/2044.
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A
Opinion Surveys on Employment-Based Health Benefits and Related Issues

The following questions were part of surveys conducted by the Gallup Organization for the Employee Benefit Research Institute (EBRI). Unless otherwise indicated, responses to questions represent combined results for November and December 1991 surveys. For these surveys, IOM staff worked with Dallas Salisbury, William Custer, and Laura Bos of EBRI to develop the questions. For some questions, certain response categories have been omitted in this summary. As a result, and also because of rounding errors, the totals below may not add up to 100.

Do you currently have health care coverage through either a health insurance plan, a health maintenance organization, or a government program?

Yes

85%

Of "Yes" respondents, source of coverage (could list more than one):

Employer (own/family member) program

63

Government program

18

Purchased on own

13

Other answer

11

Have you or a family member ever passed up a job opportunity or stayed in a job you would have preferred to have left solely because of health benefits? (November 1991 survey)

Yes

11%

Aged 18-34

17

Aged 35-54

10

Aged 55 and over

4

Suggested Citation:"A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES." Institute of Medicine. 1993. Employment and Health Benefits: A Connection at Risk. Washington, DC: The National Academies Press. doi: 10.17226/2044.
×

Which of the following best describes the reason you or your family member chose not to change jobs? (November 1991 survey)

Prospective employer did not offer health benefits

26%

You or someone in your family had a medical condition the prospective employer's health plan did not cover

9

Health benefits provided less coverage than you or a family member had previously

24

The prospective employer's health plan cost too much

19

None of these

20

For your own health care and that of your family, which of the following is your biggest concern? (December 1991 survey)

Cost

49%

Quality

36

Access and availability

12

Everything/all

1

For society as a whole, what do you think the biggest problem in health care is? (December 1991 survey)

Cost

79%

Access and availability

13

Quality

6

In the last few years, has your health insurance coverage? (November 1991 survey)

Gotten better overall

16%

Gotten worse overall

24

Which best describes your satisfaction with your health benefits? (November 1991 survey)

Satisfied

64%

Would rather have additional health benefits and less salary

20

Would rather have additional salary and fewer health benefits

7

How much more money would you or your family member's employer have to give you each year to make you willing to give up your current employer-provided health benefits? (September 1991 EBRI/Gallup survey)

0-$1,000

11%

$1,001-$3,000

19

Suggested Citation:"A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES." Institute of Medicine. 1993. Employment and Health Benefits: A Connection at Risk. Washington, DC: The National Academies Press. doi: 10.17226/2044.
×

$3,001-$5,000

15

$5,001 or more

22

Don't know

29

How would you characterize your health plan? (November 1991 survey)

Most of it is too hard to understand

 

10%

<12 grade education

15

 

Some college

12

 

College graduate

5

 

Some of it is hard to understand

 

36

It is easy to understand

 

52

Does your employer offer you a choice of two or more health insurance plans or is only one plan available to you? (November 1991 survey)

Offers choice

36%

Only one plan available

36

Not applicable/no employer

26

How do you rate your current health insurance benefits?

Excellent

27%

Good

46

Fair

20

Poor

6

Don't know

3

You are confident that your employer (your spouse's employer) contracts with the best available health insurance plan(s) for its employees. (November 1991 survey)

Agree

71%

Disagree

24

Don't know

5

Many companies, insurers, and government programs have adopted measures to eliminate unnecessary expenditures on health care and to save costs by promoting cost-effective care. Have these cost management measures resulted in any of the following? (''Yes" respondents) (November 1991 survey)

Your being denied health care services you think you needed?

9%

Your experiencing unreasonable hassle or delays in obtaining health care services?

17

Your being required to receive health care services from a physician you would not have otherwise chosen?

16

Suggested Citation:"A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES." Institute of Medicine. 1993. Employment and Health Benefits: A Connection at Risk. Washington, DC: The National Academies Press. doi: 10.17226/2044.
×

If your doctor recommends that you have a diagnostic test or treatment that is not covered by your health insurance, would you: (November 1991 survey)

Follow his or her advice and pay for it yourself

34%

Attempt to weigh the benefits of the recommendation against the cost before making a decision

20

Approach your employer or insurance company to see if an exception could be made

38

Does your household maintain a relationship with a physician who could be called your personal or family doctor?

Yes

 

76%

Male

72

 

Female

80

 

Aged 18-34

69

 

Aged 35-54

78

 

Aged 55 and over

84

 

Income under $20,000

70

 

Income $20,000 to <$75,000

79

 

Income $75,000 and >

83

 

White

78

 

Minority

69

 

In the last five years, has your household had to involuntarily change your personal or family physician?

Yes

18%

If yes to [above question], which of the following statements best describes the reason for that change? (December 1991 survey)

Doctor moved/closed practice/retired

26%

Respondent moved

15

Respondent changed jobs

15

Health plan required change/employer changed plan

17

Selected another health plan from employer

4

Other

24

Suggested Citation:"A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES." Institute of Medicine. 1993. Employment and Health Benefits: A Connection at Risk. Washington, DC: The National Academies Press. doi: 10.17226/2044.
×

Which of the following groups is in the best position to make decisions about the quality of health care provided by a hospital or physician? (December 1991 survey)

Employer

10%

Individual

55

Government

32

All the same

1

Which of the following groups do you think is in the best position to influence the cost of health care? (December 1991 survey)

Employer

11%

Individual

14

Government

28

Doctor

23

Insurers

20

All the same

2

Who do you think should be most responsible for providing health benefits for full-time employees and their dependents in the U.S.? (December 1991 survey)

Employers

48%

Federal government

31

Individual

14

All the same

3

If you had the choice, which of the following organizations would you prefer to purchase your health benefits through? (November 1991 survey)

An employer

39%

A trade association, union or professional group

8

State government

5

Federal government

16

On your own

25

Do you think employers should be required to provide health insurance if the employees pay a portion of the costs? (July 1991 survey)

Yes

83%

No

16

Suggested Citation:"A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES." Institute of Medicine. 1993. Employment and Health Benefits: A Connection at Risk. Washington, DC: The National Academies Press. doi: 10.17226/2044.
×

In general, do you strongly favor, favor, oppose or strongly oppose the implementation by the U.S. government of some type of national health insurance system? (January 1992 survey)

Strongly favor

25%

Favor

54

Oppose

14

Strongly oppose

4

Which of the following do you think is the better way to deal with our nation's health care problems? (Gallup poll for CNN and USA Today, January 28, 1992)

Reform of our current private health care system

64%

Government-sponsored national health insurance

30

Suggested Citation:"A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES." Institute of Medicine. 1993. Employment and Health Benefits: A Connection at Risk. Washington, DC: The National Academies Press. doi: 10.17226/2044.
×
Page287
Suggested Citation:"A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES." Institute of Medicine. 1993. Employment and Health Benefits: A Connection at Risk. Washington, DC: The National Academies Press. doi: 10.17226/2044.
×
Page288
Suggested Citation:"A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES." Institute of Medicine. 1993. Employment and Health Benefits: A Connection at Risk. Washington, DC: The National Academies Press. doi: 10.17226/2044.
×
Page289
Suggested Citation:"A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES." Institute of Medicine. 1993. Employment and Health Benefits: A Connection at Risk. Washington, DC: The National Academies Press. doi: 10.17226/2044.
×
Page290
Suggested Citation:"A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES." Institute of Medicine. 1993. Employment and Health Benefits: A Connection at Risk. Washington, DC: The National Academies Press. doi: 10.17226/2044.
×
Page291
Suggested Citation:"A OPINION SURVEYS ON EMPLOYMENT-BASED HEALTH BENEFITS AND RELATED ISSUES." Institute of Medicine. 1993. Employment and Health Benefits: A Connection at Risk. Washington, DC: The National Academies Press. doi: 10.17226/2044.
×
Page292
Next: B REGULATION OF EMPLOYMENT-BASED HEALTH BENEFITS: THE INTERSECTION OF STATE AND FEDERAL LAW »
Employment and Health Benefits: A Connection at Risk Get This Book
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The United States is unique among economically advanced nations in its reliance on employers to provide health benefits voluntarily for workers and their families. Although it is well known that this system fails to reach millions of these individuals as well as others who have no connection to the work place, the system has other weaknesses. It also has many advantages.

Because most proposals for health care reform assume some continued role for employers, this book makes an important contribution by describing the strength and limitations of the current system of employment-based health benefits. It provides the data and analysis needed to understand the historical, social, and economic dynamics that have shaped present-day arrangements and outlines what might be done to overcome some of the access, value, and equity problems associated with current employer, insurer, and government policies and practices.

Health insurance terminology is often perplexing, and this volume defines essential concepts clearly and carefully. Using an array of primary sources, it provides a store of information on who is covered for what services at what costs, on how programs vary by employer size and industry, and on what governments do—and do not do—to oversee employment-based health programs.

A case study adapted from real organizations' experiences illustrates some of the practical challenges in designing, managing, and revising benefit programs. The sometimes unintended and unwanted consequences of employer practices for workers and health care providers are explored.

Understanding the concepts of risk, biased risk selection, and risk segmentation is fundamental to sound health care reform. This volume thoroughly examines these key concepts and how they complicate efforts to achieve efficiency and equity in health coverage and health care.

With health care reform at the forefront of public attention, this volume will be important to policymakers and regulators, employee benefit managers and other executives, trade associations, and decisionmakers in the health insurance industry, as well as analysts, researchers, and students of health policy.

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