For some people with employer-sponsored health insurance, a new calendar year means a new healthcare plan. In recent years, many employers have encouraged employees to consider high-deductible health plans – or, in some cases, have made an HDHP the only option. These plans’ premiums tend to be lower than those of other plans, but require enrollees to cover the full cost of most care until they’ve met the deductible. In 2014, the average HDHP deductible was $2,099 for an individual and $4,332 for a family.
Economists have suggested that people with traditional insurance coverage over-consume healthcare because each doctor visit or lab test requires a relatively low co-payment. If we paid more for each service – had “skin in the game” – the thinking goes, we’d be more judicious about the healthcare we consume and shop around for the best value. Theoretically, this could result in lower (or at least slower-growing) healthcare expenditures without worse health outcomes. (Of course, all this assumes healthcare is similar to other consumer goods, when in fact there are some important differences.)
A few months ago, I wrote about one old study and one new one that found when faced with higher costs for healthcare services, consumers do indeed use less care – but they don’t become smarter about which care to use. Now, another study reports that people with HDHPs are no more likely than people with traditional plans to look for the best price when purchasing medical care.
In a Research Letter published in JAMA Internal Medicine, Anna D. Sinako of the Harvard TH Chan School of Public Health and colleagues report on their survey of a nationally representative sample of US adults ages 18-64 who used medical care in the past year. They asked participants about their attitudes towards price shopping and whether they compared costs between different providers when they most recently received medical care. The authors report:
During their last use of medical care, HDHP enrollees were no more likely than enrollees in traditional plans to consider going to another health care professional for their care (n = 120 [10.9%] vs n = 85 [10.0%]; P = .67), or to compare out-of-pocket cost differences across health care professionals (n = 42 [3.8%] vs n = 23 [2.7%]; P = .37).
Simply increasing a deductible, which gives enrollees skin in the game, appears insufficient to facilitate price shopping. Members of HDHP and traditional plans are equally likely to price shop for medical care, and they hold similar attitudes about health care prices and quality.
Lower premiums might still make HDHPs attractive for employers and for enrollees who don’t need much healthcare. But the evidence is mounting that they’re not turning people into smarter consumers of healthcare.