Health Plan Switching: Choice Or Circumstance?

Abstract

Data from the Community Tracking Study give a glimpse of who among the privately insured are likely to switch plans, and why.b y P e t e r J. Cu n n i n g h a m a n d L i n d a K o h n C h a n g i n g h e a l t h p l a n s may be beneficial to the extent that it results from consumers' decisions and preferences about what type of health plan best suits their health care needs. On the other hand, consumers today are not only choosing a plan to finance the use of services, but within that decision are also choosing a delivery system or network of providers. Therefore, changing health plans may lead to a change in physicians, which may prove harmful to continuity of care, access, and quality. 1 The extent to which changes in health plans are beneficial or potentially harmful depends on the answers to several key questions: How frequently are changes made, especially by vulnerable populations who are already at risk for problems with medical care access and quality? To what extent is changing plans voluntary (for example, consumers exercising choice) or involuntary (for example, forced changes by employers)? How often does changing health plans lead to a change in the place that persons usually receive medical care?Previous studies have been limited to the experience of a single company, which makes it difficult to generalize to the privately insured population as a whole.2 Using data from the 1996-1997 Community Tracking Study (CTS) household survey, this study is among the first to examine consumers' switching among private insurance plans nationwide. Data And Methodsn Data. The CTS is a major initiative of the Robert Wood Johnson Foundation (RWJF) to track changes in the health care system over time and to gain a better understanding of how health system changes are affecting people.3 The CTS household survey was designed to produce representative estimates for the U.S. population as well as for sixty randomly selected communities. The sample was based on random-digit dialing, as well as on a small field sample to represent households without telephones. A family respondent was selected to report on health insurance coverage (among other factors) for other persons in the family included in the survey (all adults and one randomly selected child). 4 The overall response rate for the household survey was 65 percent for families.The sample includes 32,732 families and 60,446 individuals. The sample for this analysis includes 37,545 nonelderly persons who were privately insured throughout the survey year (1996)(1997). 5n Determining plan switching. We include both employer-sponsored private insurance and private insurance plans that are purchased directly by the enrollee. For persons covered by private insurance on the day of the interview, a change of health plans was considered to have occurred if they first enrolled in their current plan during the prior twelve months and if their previous plan was also private insurance (asked in the survey). Persons continuously covered by the same private insurance plan through...

On Being New to an Insurance Plan: Health Care Use Associated With the First Years in a Health Insurance Plan

“…3 Our findings of reduced prevention, at least for mammograms, and increased testing expenditures among the newly insured are consistent with our hypotheses and the limited continuity literature. 15,16,24 These previous studies examined immunization status in children in a continuity clinic, 15 recall by Norwegian general practitioners about their testing behavior with patients with more or less continuity, 24 and self-report on prevention by respondents with and without a usual source of care.…”

“…1,2 Data from a 1996-1997 national survey suggests that 17% of privately insured persons changed their health plan in the year before the survey, most of them involuntarily. 3 Forced discontinuity associated with health plan changes is associated with reduced levels of patient satisfaction. 4 There has also been anecdotal concern that changes in health insurance might disrupt care and adversely affect outcomes.…”

Insurance Transitions and Changes in Physician and Emergency Department Utilization: An Observational Study

“…The Community Tracking Survey found that among individuals switching private insurance, over 75% was due to employer plan cancellations or a job change, and fewer than 10% switched insurance to obtain Bbetter services^such as preferred doctors. 6,24,25 More importantly, our sensitivity analyses of alternative groups designed to exclude those with potentially endogenous motivations for switching were robust.…”

“…For example, on the exchanges, individuals can change plans during the annual open enrollment process, and thus changes in premiums, coverage generosity, and individual health status may lead individuals to switch plans each year. While competition is thought to result in lower prices and improved quality of care, [2][3][4][5][6][7] it is also likely to lead to increased rates of switching among private plans as well as among private insurers participating in Medicaid as enrollees choose among plans. 3,8 The implications of plan switching with respect to health care use and the stability of patient-physician relationships may be a meaningful consideration in this environment.…”

“…Because providers are not consistently included in all insurance networks, such switching could compel patients to change physicians to avoid significant out-of-pocket expenses, which could interrupt clinical relationships and create additional costs in time and effort for both patients and physicians. 9 Prior evidence shows that individuals switching insurance carriers are more likely to have changes in their usual source of care, 6,10,11 a problem that may be exacerbated as narrow networks become more common. 12 Since prior research has focused on the transition from no insurance to insurance coverage, 2,13 there is little evidence addressing changes in health care utilization for people who switch health insurance carriers when there are no disruptions in coverage.…”