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Employees negative about health care options

June 17 2005 - Fear and anxiety drive purchasing decisions, according to a Towers Perrin study.

The study shows that employees' decisions about health care options are strongly influenced by fear and insecurity rather than by rational evaluation and decision making. The research also indicates that employees are significantly more negative than positive about both their current coverage and experience in obtaining health care.

1,400 employees of large and midsize organizations across the U.S. were studied, using a technique that measures people's emotions on a topic - specifically, views on health care coverage, care and health in general.

Over half of the people surveyed (52%) were negative about their current health coverage with most of those being intensely negative. In particular, they worried about inadequate financial protection from their current health plan, cover for the services they need (or may need) and value delivered for the cost.

Surprisingly, feelings about getting the health care experience itself are even more negative - 60% of respondents expressed negative feelings. - with fear also being the most prevalent reason. Respondents are also concerned about quality and ability to make good decisions.

"This study offers a glimpse into the psyche of the U.S. health care consumer, revealing high levels of insecurity and skepticism," said Dave Guilmette, Managing Director, Towers Perrin and leader of the firm's HR Services business health and welfare consulting practice. "People are afraid, first of all, that their insurance won't protect them against financial hardship in the event of unforeseen medical needs. They also have serious concerns about navigating the provider system -- not finding the right doctor, not knowing which tests to take, what treatments are best or which hospitals would provide the best care.

"Fear causes people to want to spend more than they need to," continued Guilmette. "People tend to think that by paying more for coverage, they will receive better value. They assume that more care is better care and that higher-priced providers are better. They are conscious of the risk of lack of care but not the risk of unnecessary care. And they tend to over-insure to minimize the risk of unbudgetable out-of-pocket cost.

"In reality, however, health care quality does not correlate directly with cost, and most company-sponsored health plans provide ample financial protection when viewed over the span of a year. Even more important, the mentality that compels people to 'throw money at the problem' runs counter to employer efforts to control costs by encouraging employees to become more effective health care consumers. Our data indicate that, if they want 'consumerism' strategies to have an impact on costs, employers must find new ways to help employees understand their coverage alternatives and gain confidence in navigating the system," said Guilmette.

Employees want predictable expenses and participants in the survey ranked covered services highest in importance when selecting a health plan with premium contributions and coinsurance also ranking high on the list of decision factors. Employees appear to be willing to contribute more up front if that investment limits their exposure to out-of-pocket costs. In the same vein, more employees (55%) are willing to take on some of the increases in the predictable components of cost (premium) than are willing to face the risks of reduced benefits (23%).

"Companies want employees to choose coverage carefully and use it appropriately. They want employees to understand care options, choose correct treatment and, most important, to live healthy lifestyles," notes Martha Terry, Principal, Towers Perrin. "Employees, on the other hand, want security, value and quality -- and they want to feel confident in their choices. Our study shows this confidence comes in part from believing their employer has a genuine concern for their health and demonstrates that concern through supportive programs and actions. Today, however, partly due to the legacy of managed care, most employers focus only on the company perspective -- costs, limitations, what to do and not to do. As a result, the fear factor -- created in part by employers themselves -- creates skepticism among employees about company motives and intolerance for company actions."

The researchers suggest that, in order to counter the fear factor, organizations must consider their employees' emotional response when formulating and implementing their health care strategies. That will allow them to effectively align their interests with those of employees and create more positive employee health care decision making and behavior.

"Companies need to start engaging employees in a dialogue that focuses on employees as health care consumers, and demonstrates the value and quality of their health care choices and the value of managing risks over time," said Martha Terry. "That focus should also address employees' fears and highlight how the employer and coverage options can meet their needs effectively."

More positive behaviors emerge if organizations demonstrate commitment, and support their employees' health care decision-making process. As an example, the survey shows that among employees who said their oragnization makes efforts to support affordable, quality care and good health for employees, more than half (54%) qualified as relatively good health care consumers based on a set of 11 behavioral factors, including:

  • carefully evaluating coverage options
  • having regular check ups
  • following doctors' recommendations

In contrast, of those who regarded their company as not being committed to employee health, only 36% reported behaviors that would qualify them as good consumers.

A similar finding is that 56% of employees who have access to and use employer-provided health care resources and decision support tools, e.g.

  • online access to health care information
  • tools to support coverage decisions
  • care management programs
  • report good consumer behaviors compared with 30% of those who do not have or use such resources.

More information about Towers Perrin HR Services is available at

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