Although this year's health insurance increases for University employees are lower than the national trend, employees have reacted with emotions ranging from understanding to frustration.
The University recently mailed employees an announcement of the changes--including monthly premium hikes of $5 for individuals and $37 for family members under the most popular of the three University plans, Duke Select, which covers 80 percent of employees. The premium changes represent a hike of approximately 8 percent, compared with national increases of about 12 percent.
Employees had the option of changing their insurance for next year during an open enrollment period from Oct. 7 to 19. No information is available yet on how many chose to change their plans.
The most significant increases under the plans are in co-payments, the amount individuals themselves pay for certain medical services. For example, this year's changes add co-pays of $250 for inpatient care, $125 for outpatient surgery and $100 for magnetic resonance imaging scans.
"Duke was able to keep its premium increases below the state and national averages by balancing the increased cost between monthly premiums and out-of-pocket costs for specific services," wrote Lois Green, director of benefits at the Medical Center, in an e-mail. "This balance helps keep premiums more affordable for employees and their families."
The health plan's structure now places a greater burden on patients who require more expensive care.
"Because the plan changes are based on usage of specific services, the changes will affect a much smaller percentage of employees," Green wrote. "Inpatient care, for example, was necessary for less than seven percent of those covered last year."
Hikes in insurance rates have been attributed to national increases in medical service costs-especially for pharmaceutical drugs and specialty services like MRI scans, a higher frequency of emergency room visits and the rapidly increasing membership of both employees and family members under Duke's plans.
Duke's coverage is predicted to expand to 43,545 members next year-an increase of 12 percent over last year. Coverage expansion and increasing costs are both contributing to the University's predicted $75 million price tag for providing employee insurance in 2003, an increase of nearly $30 million since 1999.
Many employees, however, reacted unfavorably to the price raises. "I hate [the changes]," said Tammy Hope, manager of Chick-fil-A, who changed her plan for next year because she could no longer afford her old plan's monthly rate.
Hope called the increases unreasonable for someone earning an average income. "If you have a family, you have a variety of insurance [plans] and every one has gone up," she said. "Half my check goes for insurance."
Brad Simmons, department coordinator for electronics in the Duke Store and a professor of percussion in the department of music, expressed frustration that consistent increases in health insurance prices and parking fees, erase raises in salary. "If you're going to up the health insurance, at least make the raise [in wage] go along with that," he said. "Make it worthwhile to work here."
Chris Conover, director of the Sanford Institute of Public Policy's health policy certificate program and also a member of the Faculty Compensation Committee, the group which helped advise the University on the health plan changes, said if Duke chose not to raise their insurance rates, they would have to make up the difference in salary anyway.
"It would be irresponsible [for Duke] not to make some changes," he said.
Thomas Metzloff, professor of the practice at the School of Law and chair of the committee, said he considered the changes unfortunate but necessary.
"Duke has the right approach," he said. "They've done a pretty good job of controlling costs so far."
Metzloff said the committee initially disagreed with the University on only a few details, successfully recommending, for example, that physical therapy and drug co-pays stay at the same level.
Conover agreed the changes were modest in light of larger state and national increases. "We're not unusual in facing these premium increases," he said. "We should be grateful they're not increasing more than they are."
Duke is able to offer relatively cheap insurance because of its large size and its ability to provide nearly all of its own medical care, Conover said.
Shara Player, staff specialist in the department of mathematics, echoed Conover's sentiments.
"The changes really don't bother me that much," she said. "The price for health insurance is pretty cheap here."
With no end in sight for cost increases, the bigger issue lies in the future, said Metzloff. "If it continues, it's going to hurt more and more.... This is a huge dollar issue for the Medical Center," he said.
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