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Consumer Behaviors under High-Deductible Health Plans

By December 6, 2017December 7th, 2017Commentary

High-deductible health insurance plans create financial stress for patients, and for providers who have to figure out how to collect from those patients.  The plans are supposed to encourage in behaviors like saving for future medical expenses, price shopping and prudent care-seeking.  A study published in the Journal of the American Medical Association Internal Medicine examines the extent to which they actually engage in those behaviors.   (JAMA Int. Med. Art.)   The survey was composed of 1637 adults under age 65 who were in a high-deductible plan, with the great majority have employer-sponsored coverage and about half saying they had at least one chronic condition.  About 60% had a savings account of some type attached to the plan.  The respondents were asked about their use of four behaviors:  saving for anticipated health expenses; comparing the price or quality of services from different providers; discussing price with a provider and negotiating a lower price.  40% said they engaged in saving, 25% said they talked to a provider about price, 14% compared prices across providers, usually online, 13% compared quality across providers and 6% actually negotiated for a lower price, usually in regard to drugs or outpatient visit costs. Among those respondents who said they compared prices and/or tried to negotiate, about half ended up paying less.  Unfortunately there was no comparison group in the study, so can’t tell if people with high-deductible coverage engaged in more or less of these behavior.  I suspect it would be more.  Although the authors felt use of the behaviors was low, depending on actual health needs, it seemed like a fairly good rate of these behaviors to me.  Actually negotiating lower prices is a hard thing to expect in the context of medical care, where the patient wants a non-adversarial, very warm relationship with their provider.  As people’s experience with the plan’s grow, they might become more sophisticated consumers and engage in these behaviors even more frequently.

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