Earlier this year, Glassdoor, a jobs and recruiting website, asked workers in various industries to rate how satisfied they were with their health insurance.
As it turns out, people in the healthcare industry themselves rated below average for employee satisfaction with benefits, ranking 14th out of the 20 industries represented on the survey. "People who work at car dealerships do not all drive new cars," says Andrew Chamberlain, chief economist at Glassdoor and co-author of the study. "There doesn't necessarily have to be a connection between what the industry produces and what the workers in that industry actually get for themselves."
(The industry that rated the lowest in terms of employee satisfaction with health insurance benefits was Restaurants, Bars, and Food Services. Above that was Consumer Services, which Glassdoor considers to be companies such as hair or nail salons, and next was Retail.)
While Glassdoor's research did not specifically look at why healthcare workers might be so dissatisfied with their employer-sponsored health insurance, Chamberlain speculates that a couple of factors could be at play here. One reason is that the workforce in the healthcare industry is extremely diverse, with very specialized and highly-paid physicians at one end and relatively lower-skilled, middle income positions like pharmacy techs and medical assistants at the other. Those very different labor markets are going to have varying abilities to command good benefits.
Chamberlain also says that compared to other industries, the healthcare industry is quite diffuse regarding company size, ranging from large hospitals to smaller independent practices. Because of economies of scale, larger companies are more able to provide lavish healthcare plans, he says, whereas small private practices, which could have as few as ten or less employees, are in a weaker bargaining position with the health insurance providers. They therefore aren't able to secure as desirable packages and rates for their employees.
Shenitta Moore, is one such medical professional who is not pleased with her own health insurance. A 32-year-old psychiatrist in Mississippi, she recently completed her residency at a large academic hospital where she was very happy with her coverage. But when she then took a staff position at a relatively smaller hospital, she became dissatisfied with her new health insurance plan.
"I feel like I've gotten worse insurance now than I had when I was in training," Moore says. She was offered a choice of two plans and selected the better of the two, but even so she cites a high deductible and copays for primary care visits that are more than they were with her previous plan.
Another concern for Moore is the limited options she has for in-network providers. "You can't really choose," she says. "Well, you can choose, but it's going to cost you more." The irony here lies in the fact that while Moore is constantly surrounded by experienced healthcare staff—they are literally her peers—her own options for treatment are limited.
Moore now pays a lower monthly premium—about half of what she paid before—but it comes with a tradeoff of higher out-of-pocket costs and less choice for providers that doesn't seem worth it to her. "[The premium] is less expensive, but I guess you get what you pay for," she says.
A. Mark Fendrick, physician and director of the University of Michigan Center for Value-Based Insurance Design, sees the type of situation that Moore is encountering as a disturbing trend in health insurance across all industries—the growth of high-deductible health plans.
To take a step back, when considering whether insurance is good or bad, Fendrick notes that it's highly subjective. A high-premium, low-deductible plan would be good for someone who is risk-averse, perhaps has a known health concern, and doesn't mind paying more for their premium each month for the tradeoff they get of lower out-of-pocket costs, access to a wider network of providers, and possibly a broader range of services covered. Those who want to keep their monthly expenditure low, have no known health concerns, and don't mind shopping around for services might prefer a low-premium, high-deductible plan.
While this choice may be subjective, high-deductible plans come with a very real risk. "I am very, very fearful of the growth of high-deductible health plans…because people do not realize the extent they have to pay out-of-pocket even when they have an insurance card to get the care they need," Fendrick cautions.
And this is the direction that healthcare seems to be going; because of concerns about over-insurance, Fendrick told me that employers regardless of industry are moving in droves from overly rich plans with high premiums and low out-of-pocket costs, to high-deductible health plans with lower premiums. The way these types of plans are structured shifts more of the financial burden from the employer, who covers a high percentage of the premium, to the employee, who is responsible for out-of-pocket costs, which, in plans with a high deductible, could soar.
"Young people think they're kind of invincible and are more than happy to enroll in a skinnier plan and roll the dice that when they're mountain biking or walking across the street everything goes well," Fendrick says. "The folks who tend to be most negatively impacted by [high-deductible health plans] are those who are socioeconomically vulnerable, and those with chronic medical conditions."
While there are trends in employer-sponsored health insurance by industry, the overarching issue is that, regardless of industry, the move towards less choice could negatively impact a lot of people. But Chamberlain points out that the system we have now where health insurance is provided by employers was not always the case in the US, and is not the case in many other countries around the world. Our current system developed during World War II when there were wage controls in place that made it impossible for employers to attract talent by raising pay, he explains. So the federal government allowed companies to compete for talent by offering employer-provided health insurance, and after the war ended this new system remained.
Chamberlain believes that it's important to recognize that the way health insurance is currently offered in our country is not the only possibility. "I like to tell that story to make people think creatively about all the ways that we can get people the insurance and healthcare that they need," Chamberlain says. "Having it bundled up with your company is just one way—there are other places in the world that do it differently."