hgh(Reuters Health)—High-deductible health insurance plans have been tied to lower healthcare spending, but a new study suggests the reason is not that enrollees in those plans are savvier.
High-deductible plans have lower premiums, but when enrollees need medical care, it costs them more out-of-pocket. Researchers had expected that these patients are spending less because they’re shopping around among healthcare providers for better prices.
But they aren’t. Instead, enrollees in these plans may just be using less healthcare because they face higher costs, the researchers say.
“We thought that we would see greater price shopping, we didn’t expect to find no difference at all,” says Neeraj Sood of the University of Southern California, Los Angeles.
Sood and colleagues surveyed more than 1,800 insured U.S. adults ages 18–64 who used medical care in the last year. About 1,000 were enrolled in high-deductible health plans, and 852 were enrolled in other plans.
Those with high-deductible plans were more often white, employed, had more education and higher incomes than others.
Most people believed, correctly, that care price and quality varies by provider, but that higher price does not guarantee better care. More than half said out-of-pocket costs were important when choosing care.
But over the previous year, only about 10% of both high-deductible enrollees and those with other plans considered going to another healthcare professional for care, and only 3 or 4% compared out-of-pocket cost differences by provider, the researchers reported online on Jan. 19 in JAMA Internal Medicine.
Although most people know that prices vary and that shopping around can get them lower costs and better care, high-deductible enrollees still don’t do it, Sood said.
“I think there are two obstacles, convenience and continuity of care,” he told Reuters Health by phone.
“If I want to shop for healthcare right now, it’s incredibly difficult to do that,” Sood said. “Most people don’t know what prices are charged by different providers, they would have to call the offices.”
Some offices may not give out that information and patients may have to call their health plans, he said.
“Some people have access to Internet-based tools that employers provide, but they can be incomplete, giving price but not quality,” Sood said. “And they don’t allow you to purchase on that website.”
Ideally an online tool would be searchable by ZIP code, return providers in a five or 10 mile radius, compare them by price and quality, and have a clickable link to make an appointment, he said.
“That’s not the way we buy healthcare,” although it is the way we do many other things, like book airline flights, Sood said.
“High-deductible health plans take advantage of an irrationally designed health care system,” Dr. Joseph S. Ross of Yale University in New Haven, Connecticut, an associate editor of JAMA Internal Medicine, wrote in an editorial.
“In fact, information about our health care system is asymmetric in that it is better understood by physicians and less so by patients, which means patients obtaining care are not truly informed decision makers,” Ross noted.
Sood pointed out that patients may not know if their medical records will easily transfer to another provider, which would be solved if patients, instead of doctors, owned their own medical records.
“If you are enrolled in a high-deductible plan, check if your employer or health plan offers a price compare tool,” Sood said.
“The verdict is still out on high deductible plans,” he added. “They save money at the healthcare system level, but there’s not enough evidence that they enable people to make smarter or value-based decisions. That’s the promise they were sold on.”
