Fowles Jinnet Briggs, Kind Elizabeth A, Braun Barbara L, Bertko John
Park Nicollet Institute, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416, USA.
Health Serv Res. 2004 Aug;39(4 Pt 2):1141-58. doi: 10.1111/j.1475-6773.2004.00279.x.
To assess the initial impact of offering consumer-defined health plan (CDHP) options on employees.
DATA SOURCES/STUDY SETTING: A mail survey of 4,680 employees in the corporate offices of Humana Inc. in June 2001.
The study was a cross-sectional mail survey of employees aged 18 and older who were eligible for health care benefits. The survey was conducted following open enrollment. The primary outcome is the choice of consumer-directed health plan or not; the secondary outcome is satisfaction with the enrollment process. Important covariates include sociodemographic characteristics (age, gender, race, educational level, exempt or nonexempt status, type of coverage), health status, health care utilization, and plan design preferences.
A six-page questionnaire was mailed to the home of each employee, followed by a reminder postcard and two subsequent mailings to nonrespondents.
The response rate was 66.2 percent. Seven percent selected one of the two new plan options. Because there were no meaningful differences between employees choosing either of the two new options, these groups were combined in multivariate analysis. A logistic regression modeled the likelihood of choosing the novel plan options. Those selecting the new plans were less likely to be black (odds ratio [OR] 0.46), less likely to have only Humana coverage (OR 0.30), and more likely to have single coverage (OR 1.77). They were less likely to have a chronic health problem (OR 0.56) and more likely to have had no recent medical visits (OR 3.21). They were more likely to believe that lowest premiums were the most important plan attribute (OR 2.89) and to think there were big differences in the premiums of available plans (OR 5.19). Employees in fair or poor health were more likely to have a difficult time during the online enrollment process. They were more likely to find the communications very helpful (OR 0.42) and the benefits information very understandable (OR 0.38). They were less likely to feel that they had enough time to make their enrollment decision (OR 0.47).
Employees who were attracted to the new CDHP plan options valued the attributes that distinguished these plans from other choices. The shift to consumer-defined plans and to the electronic provision of information, however, requires a significant increase in the communication support for all employees, but particularly for those in fair or poor health whose information needs are the most complex and individualized.
评估提供消费者定义的健康计划（CDHP）选项对员工的初步影响。
数据来源/研究背景：2001年6月对Humana公司总部办公室的4680名员工进行的邮件调查。
该研究是对18岁及以上符合医疗保健福利条件的员工进行的横断面邮件调查。调查在公开注册之后进行。主要结果是是否选择消费者导向型健康计划；次要结果是对注册过程的满意度。重要的协变量包括社会人口统计学特征（年龄、性别、种族、教育水平、豁免或非豁免状态、保险类型）、健康状况、医疗保健利用率和计划设计偏好。
向每位员工家中邮寄一份六页的问卷，随后寄一张提醒明信片，并向未回复者进行两次后续邮寄。
回复率为66.2%。7%的人选择了两个新计划选项中的一个。由于选择这两个新选项之一的员工之间没有显著差异，因此在多变量分析中将这些组合并。逻辑回归模型模拟了选择新计划选项的可能性。选择新计划的人不太可能是黑人（优势比[OR]0.46），不太可能仅拥有Humana保险（OR 0.30），更有可能拥有单人保险（OR 1.77）。他们患慢性健康问题的可能性较小（OR 0.56），近期没有就医的可能性较大（OR 3.21）。他们更有可能认为最低保费是最重要的计划属性（OR 2.89），并认为现有计划的保费存在很大差异（OR 5.19）。健康状况一般或较差的员工在在线注册过程中更有可能遇到困难。他们更有可能认为沟通非常有帮助（OR 0.42），福利信息非常易懂（OR 0.38）。他们不太可能觉得自己有足够的时间做出注册决定（OR 0.47）。
被新的CDHP计划选项吸引的员工重视这些计划与其他选择不同的属性。然而，向消费者定义的计划和电子信息提供的转变需要大幅增加对所有员工的沟通支持，尤其是对健康状况一般或较差的员工，他们的信息需求最为复杂和个性化。
