A case study of factors influencing health benefit offerings by small businesses.

摘要

If the United States is turning to consumer-driven health plans to control costs and improve access, research is needed regarding the perception of such plans among small businesses. Nearly half of Americans are employed by small businesses where access to health insurance has declined most rapidly. Reviews of the literature revealed solid theoretical bases for high expectations regarding the diffusion of consumer-driven health plans among small businesses, but relatively little information was found regarding the attitudes of small businesses toward emerging health plan models. Qualitative case studies of 6 small employers in the Ogden, Utah, area were conducted to address this problem. Data were collected from documents, archival records, and participant interviews and analyzed using memoing, coding, and iterative pattern matching. Key findings were that leaders of these firms did not believe employees could or would find adequate information about the quality and cost of health care services and alternative providers that would allow them to make effective choices. As a result of this belief, all firms maintained managed care controls on available providers and access to expensive services. The results imply that despite policy assumptions about the attractiveness of consumer-driven plans for small business, such plans may in actuality not be offered by small businesses as an alternative or replacement for managed care. Rather, high deductibles may simply be layered on top of managed care controls without a corresponding expansion of choice for employees. Some employees of participating firms engaged in both passive and active resistance to the imposition of high deductibles. Policy and plan designers will benefit from enhanced understanding of ways to diffuse consumer-driven plans in small businesses that will reduce employee resistance.