Health Reimbursement Arrangements (HRAs) and Health Savings Account (HSA) eligible High Deductible Health Plans (HDHPs) emerged as a new health care insurance models referred to as Consumer Directed Health Plans (CDHPs) in the early 2000s. The purpose of this study is to examine the association between enrollees’ prior financial experiences as they relate to health care access and use with plan choice when a Managed Care Preferred Provider Organization (PPO), HRA, and HSA eligible HDHP are offered concurrently in an ESI program. It is important to examine new health insurance structures, such as CDHPs, to better understand their impact on enrollees’ choice of health plan. Factors that determine enrollees’ plan choice can influence the distribution of socio-economic, health risk, and behavioral characteristics across plans. These factors in turn can affect the financial costs, risk pools, and long-term solvency of such plans. The theoretical framework used in this study is adapted from Andersen’s behavioral model and suggests economic enabling resources, self-perceived need for health care, predisposing characteristics, and plan cost characteristics are significant factors in Managed Care verses CDHP choice. First, descriptive statistics are used to describe the enrollee population relative to available plans. Then, multivariate analyses are used to examine hypotheses developed to examine employee earnings, prior Flexible Spending Account (FSA) participation, prior total cost sharing and Relative Risk Scores (RRS). Findings suggest first that CDHPs benefit from favorable selection, however the type of CDHP is a critical factor in the dynamics of plan choice. It is important not to categorize different forms of HRAs and HSA eligible HDHPs generically as CDHPs, but treat them as unique based upon their cost and administrative characteristics. Second, enrollees appear to select a plan that minimizes their future financial exposure based on past ESI experiences. Finally, CDHP choice and enrollee earnings may not have a simple linear relationship as suggested by prior research. Plan choice may depend largely on the dynamics between factors of economic resources, perceived need, and plan cost characteristics.

In this dissertation, I examine individual decisions in occupational choice, labor supply, and health care utilization. Occupational choice decisions of female college graduates on whether to teach or not are analyzed to understand the role of fertility and relative wages using a panel estimation method. I also compare the behavioral changes in the labor force participation among teachers and non-teachers conditional on the presence of a new-born baby. Using the human capital model where a worker decides her hours of work responding to wages, and her human capital is accumulated proportional to her hours of work, I predict that the positive relationship between entry wages and post wages. Empirical evidence suggests that the shock in entry wages may be attributed to post wage differentials. I examine individuals?? choice of health insurance plan and utilization of health care services. Empirical evidence shows that there is favorable self-selection into health maintenance organizations (HMOs) plans and that HMO members use more of office-based and hospital outpatient services. It suggests ineffectiveness of HMO plans in reducing utilization.

In this dissertation, I examine individual decisions in occupational choice, labor supply, and health care utilization. Occupational choice decisions of female college graduates on whether to teach or not are analyzed to understand the role of fertility and relative wages using a panel estimation method. I also compare the behavioral changes in the labor force participation among teachers and non-teachers conditional on the presence of a new-born baby. Using the human capital model where a worker decides her hours of work responding to wages, and her human capital is accumulated proportional to her hours of work, I predict that the positive relationship between entry wages and post wages. Empirical evidence suggests that the shock in entry wages may be attributed to post wage differentials. I examine individuals?? choice of health insurance plan and utilization of health care services. Empirical evidence shows that there is favorable self-selection into health maintenance organizations (HMOs) plans and that HMO members use more of office-based and hospital outpatient services. It suggests ineffectiveness of HMO plans in reducing utilization.