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December 1, 2017

High-deductible plans are meant to encourage patients to shop around. How's that working?

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    U.S. residents enrolled in high-deductible health plans (HDHPs) often do not shop around for care or engage in other cost-conscious consumer behaviors, according to a study published Monday in JAMA Internal Medicine.

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    Study details

    For the study, researchers conducted a survey from Aug. 26, 2016, to Sept. 19, 2016, to examine the prevalence of cost-conscious behaviors among U.S. residents enrolled in HDHPs, which have minimum deductibles of $1,300 for individuals or $2,600 for families.

    The researchers surveyed 1,637 adults ages 18 to 64 who were enrolled in an HDHP for at least 12 months. Survey questions included whether in the past 12 months respondents had:

    • Compared quality ratings or prices for a service;
    • Discussed the cost of services or negotiated a price for a service with a provider; and
    • Saved for future health services.

    The study was not controlled or designed to prove whether or how such behaviors might have an effect on the cost or quality of the care U.S. residents enrolled in HDHPs received.


    Overall, the study found few respondents practiced cost-conscious behaviors examined by the survey. For instance, the researchers found:

    • 40% of respondents saved for future health services;
    • 25% of respondents talked with a provider about the cost of a service;
    • 14% of respondents compared prices;
    • 14% compared quality; and
    • 6% of respondents attempted to negotiate a price for a service.

    The researchers found respondents who saved for health services, compared quality, and discussed the cost of services with providers said such behaviors most commonly led to them receiving help with getting a needed service. Meanwhile, respondents who compared and tried to negotiate prices said such behaviors led to them paying less for a service.

    According to the study, there are several ways providers, employers, and payers can encourage individuals with HDHPs to engage in cost-conscious behaviors. For example, the researchers said, "Health systems could make prices for services available at the point of care to facilitate patient and clinician conversations about cost," while "employers and insurers could go beyond disseminating price information to help patients learn how to use this information in health care decisions."

    The researchers said, "Such efforts will become increasingly important as enrollment in HDHPs continues to increase and could become essential if modifications to the structure or implementation of the Affordable Care Act accelerate patients' exposure to high cost sharing." 


    Jeffrey Kullgren, a research scientist at the Veterans Affairs Ann Arbor Healthcare System and an assistant professor at the University of Michigan Medical School who led the study, said the findings show few U.S. residents "in high-deductible health plans are engaging in consumer behaviors," but those who do reap benefits.

    Joel Segel, a health policy researcher at Pennsylvania State University who was not involved in the study, said, "We know consumers respond to high deductibles by reducing care and that consumers don't necessarily do a good job discriminating between necessary and unnecessary care." Segel said, "Patients should also know that if they are having difficulty meeting their medical bills that providers may be willing and have options for negotiations and helping patients afford their care."

    Franklin Wharam, a health policy and insurance researcher at Harvard Medical School who was not involved in the study, said "Consumers with the time, interest, and resources to shop for good value in health care might thrive under high-deductible health plans," but "others should consider their health benefit type carefully (if their employer offers choices) and choose the plan that optimizes their health and financial situation" (Rapaport, Reuters, 11/27; Baker, "Vitals," Axios, 11/29; Lagasse, Healthcare Finance News, 11/28; Haefner, Becker's Hospital CFO Report, 11/29; Kullgren et al., JAMA Internal Medicine, 11/27).

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