High-Deductible Member Behaviors

One of the enduring concerns regarding high-deductible health plans is whether they have a positive or negative effect on employee health behaviors-do consumers avoid needed care or do they only skip inappropriate services.  Past research has shown some of each.  A new survey detailed in Health Affairs attempts to shed further light on the topic.   (HA Article)   In an effort to help consumers make better health care decisions, many firms or insurers with high-deductible coverage offer price transparency and quality rating tools, but patients have to use those for them to be of any value.  This study surveyed over 1600 non-Medicare eligible adults who were enrolled in a high-deductible plan for at least a year.  About 84% of respondents had coverage through work and the rest through an individual plan.  They were asked a series of questions about their engagement in a number of cost-conscious behaviors and impediments or facilitators of those behaviors.

The five behaviors were saving in advance for health care costs, comparing prices, comparing quality, discussing cost of alternatives with a provider and trying to negotiate a price.  Interestingly none of these behaviors was significantly higher or lower depending on income or presence of chronic conditions, which is encouraging.  Having a health savings account feature in a high-deductible plan was associated with a greater likelihood of saving for future care and trying to negotiate prices, but not other behaviors.  Having more outpatient visits in the past 12 months was generally associated with greater use of each of the behaviors, as was having confidence in an ability to engage in the behavior.  Having a high level of patient engagement, as measured on a commonly used scale, was associated with more use of price and quality comparisons.  Having a higher lever of health insurance literacy was associated only with a slightly greater tendency to save for future health care, while a higher level of general financial literacy was associated with more use of cost and quality comparisons.  A general propensity to comparison shop for goods and services was tied to more cost and quality comparing and to more discussion of costs with a provider and attempts to negotiate price.

Facilitators of saving for future health care were identified as a company contributing to an HSA, and encouragement from the health plan, while not considering the idea, already having savings and not feeling savings could be afforded were impediments.  For comparing costs and quality, websites and health plans were identified as facilitators and not considering the idea and feeling doing comparisons wouldn’t change a decision were impediments.  Discussing or negotiating costs with a provider were encouraged by someone at the doctor’s office or the health plan or family and friends and impediments were not considering the action and perceptions that it wouldn’t change the decision or that prices can’t be negotiated.

Less than half of respondents engaged in any of these behaviors, which is discouraging, although people who used more care engaged in them more frequently, which is encouraging.  Also notable are the low levels of people even considering that these behaviors could be engaged in and feelings of pointlessness or futility in engaging in them.  As the authors suggest, there is clearly an opportunity here for health plans to do more educating on tactics to lower costs for high-deductible patients and to incentivize their use.