The Employee Health Care Value Survey: Round One

Prologue: For many years American businesses slumbered while the cost of workers’ health insurance soared. More recently, as health care costs have put a crimp in profit margins and become a more expensive fringe benefit, businesses have become more sophisticated purchasers of care and more vigilant in paring the growth of medical spending. One dimension of this significant attitudinal change is the closer attention business is paying to the quality of care rendered by providers that are affiliated with different delivery approaches. In this paper Harris Allen, a health services researcher, teamed with three corporate health insurance specialists to discuss the results of a new survey of employees regarding their views on thirty-two managed care and fee-for-service health plans. The three participating corporations (Xerox, GTE, and Digital Equipment Corporation) have seen many employees enroll in managed care programs and give up their long-standing ties to indemnity insurance and fee-for-service medicine. One interesting survey finding affirmed that consumers place a high value on selecting and dealing with a personal physician, but that various features of plan administration (such as range of coverage and costs of care) are also important. Employees who belonged to health maintenance organizations (HMOs) were significantly more satisfied with their plans than were those with fee-for-service plans, primarily because the HMOs provided more “consumer-friendly” plan administration. Nevertheless, the ratings from HMOs suffered because their enrollees had a more limited choice of doctors. Allen is a senior scientist at The Health Institute of the New England Medical Center. Helen Darling is manager, Healthcare Strategy and Programs, at Xerox; Dwight McNeill is health care information manager at GTE; and Fran Bastien is manager, U.S. Health Programs, at Digital. Abstract: In a groundbreaking arrangement, a consortium of large employers—the Xerox, GTE, and Digital Equipment Corporations—launched the Employee Health Care Value Survey during fall 1993. Completed by 24,306 employees, this survey was used to develop comparable methods for assessing corporate health care benefit strategies. It also enabled fair comparisons of thirty-two health plans across the country on more than sixty criteria. Variation in performance among plans was substantial, with managed care plans—particularly prepaid group practices and individual practice associations (IPAs)—recording the most favorable rankings on disenrollment, overall satisfaction, and other measures of “bottom-line performance.” Variation in enrollees’ health among plans was more modest, with indemnity enrollees posing a somewhat greater illness burden to their plans than enrollees of other plan types. The employers and evaluated health plans are now using the results for multiple purposes, including quality improvement initiatives, employee-based plan performance reports, employee contribution strategies, and health promotion programs.