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 Imperial County, 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, on the following page, summarizes the response to the survey. A total of 39 usable surveys were returned for a response rate of 35.8%. As mailed surveys with response rates over 30% are rare (Alreck & Settle, "Survey Research Handbook" 1985, pg. 45), this is considered a very good response rate. The names of those businesses responding to the survey can be found in the Appendix.

Source: Survey of large businesses in Imperial County, January-March, 1998

Table 8.1 Imperial County Employee Health Benefit Survey
Mailing and Response Numbers Total Surveys Mailed 109 Total Response 42 Usable Response 39

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 than those who did. It is known that people who do not respond to surveys tend to be more neutral about the survey topic or have less experience in the survey topic in their discarding of the survey. Thus, these individuals tend to be under represented in the survey results and represent potential "bias."

Limited information is known about the businesses which did not respond to this survey. By reviewing the list of non-respondents, a significant number appear to be area retail businesses and food service businesses. Frequently these 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 which did not respond. However, other similar businesses did respond so it is felt that these type of employers are adequately represented in the survey responses.

Size of businesses: Table 8.2 shows that thirty-seven businesses reported combined employment of 6,734 full-time employees and 836 part-time employees.

Summary of benefits offered: Thirty-four businesses responding to the survey reported that they offered their employees health benefits; five businesses do not offer benefits. Of those 34 who offer benefits, they also offer the additional benefits listed below:

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.

Because the survey question concerning the numbers of full-time or part-time employees was separate from the eligibility to receive health benefits questions, the number of employees receiving benefits by full-time and part-time was unascertainable. 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.

For numbers of employees eligible for benefits, it is assumed that all full-time employees are eligible for benefits, so 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 employees not being employed long enough to become eligible and employee share contributions may be prohibitive.

On the average, employees must work 20.5 hours a week to be eligible for health benefits coverage. The median number of hours was 30.

Source: Survey of large businesses in Imperial County, Jan-March, 1998

Table 8.4: Large Employers Offering Health Benefits in Imperial County
Employees Employees 7,570 Eligible for Benefits* 6,930 Receiving Benefits 4,375 Full-Time Eligible 6,734 Part-Time Eligible 196

Note: The design of the survey does not allow us to identify which of those employees receiving benefits are full-time or part-time employees. Because only a small percentage of employees who are part-time employees are eligible for benefits, it is assumed that the large majority receiving benefits are full-time employees.

Table 8.5: Full-Time Employee Benefit Percentages for Large Employers in Imperial County
Full-Time Employees Employees 7,570 Eligible for Benefits 6,734 Receiving Benefits unknown

Source: Survey of large businesses in Imperial County, Jan-Mar, 1998

Table 8.7: Part-Time Employee Benefit Percentages in Imperial County
Part-Time Employees Employees 836 Eligible for Benefits 196 Receiving Benefits unknown

Types of Health Plans Offered: Table 8.8 summarizes the types of health plans offered by large businesses in Imperial 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. (This number most likely is higher if the self-insured plans which utilize PPOs are included.) Ten employers offered more than one type of health plan, with the most frequent combination of offered plans being PPOs and HMOs.

Of particular significance is the 10 employers who identified themselves as "self-insured." In general, these employers are larger than the other businesses in this survey, with an average of 308 employees (median 167). Their choice of health benefit plans, therefore, affect a larger number of employees (see Table 8.12 below).

Source: Survey of large businesses in Imperial County, Jan-Mar, 1998

Note: Ten employers offered more than one type of health plan to their employees.

Table 8.8: Types of Health Plans Offered by Large Employers in Imperial County
# of Employers Percentage of Total Traditional Indemnity 7 15.6% PPO 20 44.4% HMO 8 17.8% Self-insured 10 22.2%

Table 8.10 summarizes the health plans mostly commonly offered by area employers. Principal, Blue Cross of California, Blue Shield and Pacificare are the most frequently named plans. Several employers who offer their employees a choice of health plans offer a PPO based in Mexicali. The advantage of selecting this PPO to both the employer and employee is significantly lower costs. From the limited information received, it appeared that premium costs were roughly half those of U.S.based plans. Unfortunately, information is not available from this survey on the extent to which these PPOs are selected by Imperial employees.

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 (54.7%) of all employees reported in this survey. The low number of employees choosing HMOs is surprising given that nearly one-quarter of the employers offer their employees an HMO option.

Source: Survey of large businesses in Imperial County, Jan-Mar, 1998

Note: Not all respondents answered this question.

Table 8.12: Types of Health Plans Elected by Employees of Large Employer
# of Employees Percentage of Total Traditional Indemnity 630  13.5% PPO 1,089  23.3% HMO 399  8.5% Self-Insured 2,557  54.7% Total 4,675 * 100.00%

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, co-insurance percentage and co-payment amounts.

Responses to this portion of the survey presented a challenge for analysis. Confusion in responding to these questions appear to fall within the following categories: 1) some employers did not differentiate between the costs of individual premiums versus family premiums, 2) some employers provided us with employee contributions but not total premium costs, 3) some employers offer their employees a combined benefit package and could not break out individual medical plan 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 appear to logically respond to the questions as intended. Thus, for employers offering PPOs, there were 12 usable responses. For HMOs, there were only five usable responses.

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.

For employers who are self-insured, only five employers out of 10 provided usable cost information on premium costs. This question was problematic for some 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 in average was found to be consistent and in line with other reported costs. Thus, caution should be used in utilizing these numbers because of the low number of respondents.

Source: Survey of large businesses in Imperial County, Jan-Mar 1998

Note: Some employers offer more than one type of health plan.

Table 8.14: Individual and Family (three or more) Premiums of Large Employers in Imperial County

Individual Indemnity PPO HMO Self-insured Avg. Employer Premium   $ 156.14 $ 149.46 $ 162.31 Avg. Employee Contribution   $ 28.11 $ 8.60 $ 5.06 Total Monthly Cost   $ 184.25 $ 158.06 $ 167.37 Family (3 or more)         Avg. Employer Premium   $ 293.93 $ 333.35 $ 358.25 Avg. Employee Contribution   $ 150.66 $ 77.77 $ 95.75 Total Monthly Cost   $ 444.59 $ 411.12 $ 454.00

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

In addition, half of PPO and self-insured plans required a co-payment for a variety of services, including physician office visits. Approximately half of PPO and Self-Insured Plans require the employees to share in a percentage of expenses for services such as hospitalizations.

Waiting Period Before Enrollment: Table 8.16 illustrates the waiting period for a newly hired employee before they become eligible to receive health care benefits. Forty percent of the employers require a waiting period of 90 days 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. Employer satisfaction is highest with the self-insured plans and lowest with traditional indemnity insurance plans.

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