Is health care consumerism really driven by consumers? Some policy analysts believe the answer is no, arguing that Americans primarily want affordable health care.

Speaking at the National Consumer-Driven Healthcare Summit on Thursday, Sara Collins, assistant vice president at the Commonwealth Fund, told attendees that the No. 1 health care concern for consumers is cost. Patients are especially concerned about whether they are protected from catastrophic events and whether they can get preventive care.

She cited research showing that 51% of high-deductible health plan users and 44% of consumer-driven health plan users spent 5% or more of their income on health care in 2006, compared to just 22% of those in traditional health plans. What's more, 38% of CDHP users and 33% of HDHP users reported delaying or avoiding care, compared with just 19% of those in traditional health plans.

"The sluggish growth in enrollment is likely related to the low ratings that people continue to give to CDHPs," Collins added.

Jim Guest, president of Consumers Union, the consumer advocacy group and publisher of Consumer Reports, asserted, "The health insurance system is broken, and the approaches under the name of consumer-driven health are not making a difference. [Consumers] certainly did not drive the creation of health savings accounts because those who enroll are more likely to spend a larger part of their income on health care."

Guest believes health care consumerism should place the consumer at the heart of the health care system and address the needs of a broad spectrum of patients. "HSAs may be great for the healthy and wealthy, but they are not good for the average citizen or folks in the low-income brackets," he added.

Collins outlined recommendations to make CDHPs more consumer-friendly, including:

• Permit employers to lower deductibles for low-wage workers with HSAs.
• Set an income ceiling on eligibility for HSAs to reduce the tax subsidy for high- income individuals.
• Exempt primary care and preventative services from the deductible.
• Exempt prescription drugs essential for management of chronic conditions from the deductible.
• Place limits on family premiums and out-of-pocket costs as percent of income; for example, 5% of income for low-income families.