Do health plans with high deductibles motivate patients to shop around?

According to recent research published in JAMA Internal Medicine, the answer may be no.

In a poll of people in the United States enrolled in high-deductible health plans (HDHPs), researchers found a minority were engaging in price shopping and other “consumer-type” behaviors.

“Our primary findings were that few Americans in high-deductible health plans are engaging in some of these strategies that can help them get the care they need at the lowest possible cost,” Dr. Jeffrey Kullgren, MS, MPH, an assistant professor of general medicine at the University of Michigan, told Healthline.

Only 40 percent of poll respondents reported saving money for future healthcare services.

Another 25 percent said they had spoken with a healthcare provider about how much a healthcare service would cost.

Another 14 percent said they had compared prices or quality ratings across services or providers.

And 6 percent had tried to negotiate the price of a service.

“Of the people who had engaged in one of those behaviors, about half of them felt that doing so either helped them get the care they needed or pay less for a service,” Kullgren said.

He suggested that more could be done to help patients with HDHPs access affordable healthcare services and make the most of their cost-sharing coverage.

High-deductible plans are on the rise

Since high-deductible health plans were first created nearly 15 years ago, enrollment has rapidly increased.

According to the Centers for Disease Control and Prevention (CDC), more than 40 percent of Americans under the age of 65 with private health insurance were enrolled in an HDHP in the first three months of 2017.

HDHPs tend to have lower monthly premiums but higher deductibles, compared to traditional plans.

Enrollees must cover at least $1,300 in healthcare costs for an individual, or at least $2,600 for a family, before their insurance company starts to pay.

“Proponents of these plans have advocated the idea that patients should act more like consumers in healthcare, that they should have more ‘skin in the game,’ that it would lead them to be more cost-conscious decision-makers in the healthcare system,” Kullgren told Healthline.

But his research team’s findings suggest that many people with HDHPs are not actually shopping around for better prices.

When another research team conducted a similar study, published this past spring, they found even lower rates of price shopping.

“What we found was if you compared people in the high-deductible plan versus people in the traditional plan, there was no difference in their price-shopping behavior,” Neeraj Sood, PhD, principal investigator of the earlier study and director of research at the Schaeffer Center for Health Policy and Economics at the University of Southern California (USC), told Healthline.

“We found that only 3 percent of patients had actually compared prices across healthcare providers,” he continued, “and only 10 percent had even thought about or considered other providers.”

According to Sood, there were two potential barriers standing in patients’ way.

First, people often find it difficult to price shop.

Second, they may be reluctant to leave their current healthcare provider, due to concerns over continuity of care.

Plans don’t promote smarter choices

Rather than motivating people to use less expensive healthcare services, HDHPs may push people to use fewer health services altogether.

“Sometimes that’s a good thing because we know that people in these plans get less low-value care that they may not need,” Kullgren said. “But the problem is that people in these plans also get too little high-value care that they do need.”

Sood has helped to conduct multiple studies on this topic, including one that was published last week in the American Journal of Managed Care.

His research team found evidence suggesting that HDHPs encourage patients to curb their healthcare spending indiscriminately, rather than cut low-value care specifically.

“A lot of the evidence is that, yes, we’re saving money, but we’re not saving money in smart ways,” he said. “We’re saving money by not going to the doctor, we’re saving money by not taking our drugs. It’s not really encouraging use of high value care.”

More needs to be done

To help patients with HDHPs access high-value care without breaking the bank, Kullgren suggested that more work needs to be done to empower them to get the most out of their plans.

“Being able to better use a high-deductible health plan may involve different skills than using a health insurance plan that’s much more generous and has less up-front cost-sharing,” he said.

It’s also important for healthcare providers and healthcare systems to become more responsive to the growing number of people with HDHPs, he continued.

For example, he suggested that price-comparison tools should be available at the point of care, so patients and healthcare providers can use that information to guide their decision-making.

He also suggested that clinicians should receive training on how to have cost-related conversations and elicit information about patients’ insurance coverage and financial needs.

“That would allow more fully informed and shared decisions-making, and maybe patients could work with members of their healthcare team to come up with treatment plans that are not only going to help them get the care they need but also do so at the lowest possible cost,” he said.

“There are a host of other strategies that policymakers have been discussing about how to overcome some of the challenges of these plans,” he added, “but to help people now as opposed to at some unclear point in the future, we need to help them better navigate their plans as they are.”