B. Survey Findings

A Note about the Charts: The Developing Rural Integrated Programs (funded by the James Irvine Foundation) is currently underway in five different locations in California. To allow comparison across sites, specific charts were developed for the display of data. In some of the other regions which are significantly smaller than the Humboldt/Del Norte region, both large (more than 25 employees) and small employers were surveyed. The charts presented here are only for the large employers; charts for smaller businesses are omitted. Therefore, the numbering of the charts in this section is not sequential.

Response: Table 8.1 summarizes the response to the survey. A total of 57 usable surveys were returned for a response rate of 38.8%. As mailed surveys with response rates over 30% are rare (Alreck & Settle, "Survey Research Handbook" 1985, pg. 45)¹² , this is considered a very good response rate. The names of those businesses responding to the survey can be found in the Appendix.

Table 8.1 Humboldt/Del Norte Employee Health Benefit Survey

Mailing and Response Numbers Total Surveys Mailed 147 Total Response 64 Usable Response 57
Source: Survey of large businesses in Humboldt/Del Norte Counties, November, 1997

Non-Respondent Bias: One of the limitations of a mailed survey is the fact that respondents who did not reply may in some manner be different from those who did. It is known that people who do not respond to surveys tend to be more neutral about the topic or have less experience in the survey, resulting in their discarding it. Thus, these individuals tend to be under represented in the results and represent potential "bias."

Although limited information is known about the businesses that did not respond to this survey, by reviewing the list of non-respondents, it was noted that a significant number represented area retail businesses and food service businesses. These frequently were recognizable names of large national chains. Potential reasons for non-response could include: 1) these businesses are more likely to employ part-time employees and may not offer benefits, and 2) information on health benefits is not coordinated locally but at a larger regional office outside the area. There were a few other governmental or commercial large businesses that did not respond. However, other similar businesses did, so it is felt that these type of employers are adequately represented in the responses.

Size of businesses: As reported in Table 8.2, the 57 businesses reported combined employment of 10,598 full-time employees and 2,834 part-time employees.

Table S.8.2-1: Number of Employees per Business by Work Status

Number of Businesses Average # Employees per Business Median # of Employees per Business Full-time Employees 57 185 98 Part-time Employees 42 67.5 26

Source: Survey of large businesses in Humboldt/Del Norte Counties, Fall 1997.

Summary of benefits offered: All 57 businesses responding to the survey reported that they offered their employees health in addition to other benefits.

Employees Eligible to Receive Health Benefits: The next three tables present information on the numbers of employees receiving health insurance as a benefit from their employment. Table 8.4, provides an overview of all employees reported in the survey and Table 8.5 and Table 8.7 illustrate information on full-time and part-time employees respectively. (Note: Information regarding employee numbers, full-time status and benefit eligibility are asked in separate questions that cannot be linked. Therefore, the number of employees eligible to receive benefits assumes that all full-time employees are eligible plus those part-time employees who were identified as being eligible to receive benefits.)

Table 8.4: Large Employers offering Health Benefits in Humboldt/Del Norte

Employees Employees 13,432 Eligible for Benefits* 11,216 Receiving Benefits 9,642   Full-time Eligible 10,598 Part-Time Eligible 618
Source: Survey of large employers in Humboldt/Del Norte Counties, November, 1997

Table 8.5: Full time Employee Benefit Percentages

Employees Employees 13,432 Eligible for Benefits 10,598 Receiving Benefits unknown
Source: Survey of large businesses in Humboldt/Del Norte Counties, November, 1997

Table 8.7: Part time Employee Benefit Percentages in Humboldt/Del Norte

Part-Time Employees Employees 2,834 Eligible for Benefits 618 Receiving Benefits Unknown
Source: Survey of large businesses in Humboldt/Del Norte Counties, November, 1997

There is a design problem with these three charts in that the survey asks information about numbers of employees, their full-time or part-time work status, and their eligibility to receive health benefits in different questions that cannot be linked in a manner which provides reliable information. Also, some employers did not answer all questions. Others who offer their employees more than one choice of health plan, reported total numbers of employees as eligible for each type of health plan offered, thus resulting in a double counting of eligible numbers. These are problems that arose when the survey instrument was mailed rather than being completed in person or over the phone.

For numbers of employees eligible for benefits, it is assumed that all full-time employees are eligible for benefits; the number of part-time employees eligible was collected. This number is believed to be fairly accurate. The number receiving benefits must be considered less accurate due to lack of responses and the problem of double counting of employees as described above. Regardless, it is believed that a considerable number of employees are not receiving benefits. Reasons for this may include not being employed long enough to become eligible and employee share contributions may be prohibitive to some.

On the average, employees must work 25.9 hours a week to be eligible for health benefits coverage. The median number of hours was 30.

Types of Health Plans Offered: Table 8.8 summarizes the types of health plans offered by large businesses in Humboldt/Del Norte County. Four choices were given, including Traditional Indemnity (fee-for-service), Preferred Provider Organizations (PPO), Health Maintenance Organizations (HMOs) and Self-Insured (with major stop loss insurance). PPOs were identified as the most common type of health plan offered by area employers, followed by HMOs. Twelve employers offered more than one type of health plan, with the most frequent combination offered being PPOs and HMOs.

Table 8.8: Types of Health Plans Offered

# of Employers Percentage of Total Traditional Indemnity 7 9.6% PPO 29 39.7% HMO 23 31.5% Self-insured 14 19.2%
Source: Survey of large businesses in Humboldt/Del Norte Counties, November, 1997
Note: Twelve employers offer more than one type of health plan.

Of particular significance are the fourteen employers who identified themselves as "self-insured." In general, these employers are larger than the other businesses in this survey, with an average of 446 employees (median 219). As documented in Table 8.12, on the following page, their choice of health benefit plans, therefore, affect a larger number of employees. 

Table 8.10 summarizes the health plans mostly commonly offered by area employers. Blue Cross of California’s Preferred Provider and CaliforniaCare plans are the dominant health plans offered by area employers. This may be because Blue Cross is the only company offering both a PPO and a HMO option in the Humboldt/Del Norte area, making it attractive to those businesses that offer their employees more than one health plan option. Table 8.12 summarizes the numbers of employees enrolled in the various health plans. Again, not all employers completed this question. Regardless, the significant factor here is those large employers who are self-insured account for over half (54.3%) of all employees reported in this survey. The low number of employees choosing HMOs is surprising given that nearly one-third of the employers offer their employees an HMO option.

Table 8.12: Types of Health Plan Elected by Employees of Large Employers in Humboldt/Del Norte

# of Employees Percentage of Total Traditional Indemnity 753 7.8% PPO 2,744 28.5% HMO 909 9.4% Self-insured 5,236 54.3% Total 9,642 *
Source: Survey of large businesses in Humboldt/Del Norte Counties, November, 1997
* Not all respondents answered this question.

Premium Costs: In this section, employers were asked to provide information on various cost factors of individual and family (more than three individuals) premiums, including monthly premium costs, monthly employee contributions, annual deductible, coinsurance percentage and co-payment amounts.

Responses to this portion of the survey also presented a challenge for analysis. Confusion in responding to these questions appears to fall within the following categories: 1) no information was provided because it was considered proprietary, 2) some employers did not differentiate between the costs of individual premiums versus family premiums, 3) some employers provided us with employee contributions but not total premium costs and 4) some employers who were part of a larger organization did not actually have cost data available. In these instances, results were tallied only for those responses which appeared to answer the questions logically as intended. Thus, for employers offering PPOs, there were 19 responses for individual premium costs and 20 responses for family premium costs. For HMOs, there were 19 responses for individual premium costs and 15 for family premium costs. The results are summarized in Table 8.14, on the following page.

Cost information supplied by employers with traditional health insurance is not reported because of the low number of responses and the extreme variability of reported premium costs (i.e., one plan reported individual costs of $28/month with a $2,000 deductible and another reported monthly individual costs of $411/month with a $300 annual deductible.)

For employers who are self-insured, only six employers out of 14 provided usable cost information on individual premium costs and seven provided information on family premiums. This question was problematic for many employers who are self-insured because they do not calculate their own costs in this manner. However, the information supplied by the employers which is presented was found on average to be consistent and in line with other report costs. Caution should be used however in utilizing these numbers because of the low number of respondents.

Table 8.14: Individual and Family (three or more) Premiums of Large Employers in Humboldt/Del Norte

Individual Indemnity PPO HMO Self-Insured Avg. Employer Premium   $130.51 $126.67 $153.48 Avg. Employee Contribution   $21.24 $22.47 $15.15 Total Monthly Cost   $151.75 $149.14 $168.63 Family (3 or more)         Avg. Employer Premium   $296.79 $300.61 $321.31 Avg. Employee Contribution   $98.96 $96.54 $78.63 Total Monthly Cost   $395.75 $397.15 $399.94

Source: Survey of large businesses in Humboldt/Del Norte Counties, November 1997

Note: Some employers offer more than one type of health plan. Not all employers provided usable cost information.

While all health plan options appear to have similar premiums, it is also important to factor in the annual cost of deductibles which an employee is required to pay. These are summarized below:

In addition, approximately half of PPO plans required a co-payment for a variety of services, including physician office visits. There were no similar charges for HMO or Self-Insured Plans. Finally, nine of the PPO options required cost-sharing of expenses for services such as hospitalizations.

Waiting Period Before Enrollment: Table 8.16 illustrates the waiting period for newly hired employees before they become eligible to receive health care benefits. Over half the employers require a waiting period of 90 days or more before eligibility begins.

Satisfaction with Health Plan: Table 8.17 presents the average ranking of employers of their health plans, using a 1-5 Likert scale with 1 = Very satisfied. Often such averages tend to obscure the distribution of individual responses. Because all these averages are so close, a more detailed breakdown of the distribution of responses is presented in Table S.8.17-1, on the following page. These results show greater variation in reported satisfaction between the various types of health plans.

Table S.8.17-1: Distribution of Ranking of Health Plans by Employers, by Percentage

Question: On a scale of 1-5, how would you rate your satisfaction with your health plan coverage? 1= Very Satisfied; 5 = Very Dissatisfied.

Very Satisfied "1"     "2"     "3"     "4" Very Dissatisfied "5" Traditional Indemnity (N = 7) 57.1% 14.3% 14.3% -- 14.3% PPOs (N = 27) 14.8% 48.1% 26% 3.7% 7.4% HMOs (N=21) 19% 47.6% 23.8% 4.8% 4.8% Self-Insured (N = 11) 27.3% 18.2% 45.5% 9.0% --

Source: Survey of large businesses in Humboldt/Del Norte Counties, Fall 1997.

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