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People With High-deductible Plans Aren’t Acting Like Savvy Consumers

More and more Americans have health insurance that requires them to open their wallets for the first few thousand dollars' worth of care they receive every year, before the insurance coverage kicks in.

But a new study suggests that despite the rise in these high-deductible health plans (HDHPs), most Americans who have them aren't saving, shopping around for better prices, talking to their doctors about costs, or making other consumer-type moves.

When they do, they get help about half the time, according to the new study published in JAMA Internal Medicine by a team from University of Utah Health and the University of Michigan.

"Even when people knew they could act like consumers, they found it was difficult to do and thought it wasn't helpful," said Angie Fagerlin, Ph.D., chair of Population Health Sciences at U of U Health. "We need to think much more about how we can help patients become successful health care consumers."

Consumer-oriented plans, but not consumer behavior

The study, based on a national poll of 1,637 adults under age 65 who had HDHPs for at least a year, provides new insight into the behavior of people with a type of insurance that many employers have turned to in an effort to reduce their own health care costs.  

More than 40 percent of American adults have an HDHP, according to the Centers for Disease Control and Prevention. The plans, which require individuals to pay at least the first $1,300 of their own costs, and families the first $2,600, often are offered with a tax-protected health savings account to help people stash away money to pay for their future care needs.

The vast majority of the poll’s participants got their HDHPs through an employer, although such plans can also be bought on the Affordable Care Act individual insurance exchanges and directly from insurers. Some policymakers have championed the plans as a way of giving patients “skin in the game” when it comes to their health care costs. 

Employers often encourage people enrolling in HDHPs to put away money for when they need it, to research costs and quality ratings at different providers and health care facilities, to talk with their doctors and other providers about costs, and to negotiate prices for services they need.

But the researchers found that many people aren’t pursuing these “consumer” behaviors.

Key findings from the study include:

  • In all, 58 percent of poll participants said they had an account to put aside money for medical expenses, including HSAs. But only 40 percent of the entire sample had actually saved any money for their future medical costs.
  • Only 25 percent had talked to a healthcare provider about the cost of a service.
  • Only 14 percent had compared prices for the same service or product, or the quality ratings for different providers.
  • Only 6 percent had tried to negotiate the price of a health care service, either in advance or after they received a bill for a service they’d received.

The also poll asked how engaging in consumer behaviors helped them. Key findings include:

  • 45 percent of those who had compared prices said it helped them pay less for a service.
  • Among the 445 people who had talked to a provider about cost, 45 percent said that having this discussion had helped them get care they needed.
  • Among the 685 who had saved money for their medical care, just over half said that this practice had helped them get care they needed in the past year.

“Most Americans in HDHPs are not doing things that can help them get the care they need at the lowest possible cost, and even those who are doing so could realize more benefits,” says lead author Jeffrey Kullgren, M.D., M.S., M.P.H., an assistant professor of general medicine at U-M.

The researchers conclude that health care providers, insurers and employers could do more to help people in HDHPs. For instance, providers could help people in HDHPs understand their possible future medical needs so they can try to save for them.

Also, health care facilities could make prices available at the point of care so that patients and providers can talk about cost. And employers that offer HDHPs could offer more than just price information to help employees learn how to use this information in their decision-making.

Kulligan and colleagues are studying what tools, interventions and policies can be used to help encourage more consumer-like behavior among people in HDHPs, and what people say actually helps them use this form of insurance wisely. Using research on health-related behavior, and the value of particular types of care for patients with specific conditions, they hope to go beyond information and education.

“Given the continued growth in these plans, we have to figure out how to better help consumers,” says Kullgren. “And if we only focus on the consumer side, we circumvent the role of doctors and other providers as an agent for the patient – we shouldn’t expect patients to be their own doctors.”

The study was supported by the Robert Wood Johnson Foundation.

- Modified from a press release by Kara Gavin, University of Michigan