The rise of the high-deductible health plan was partially driven by the belief that if consumers have more "skin in the game" — as economists call it — they will be incentivized to make smarter, more cost-effective healthcare decisions. However, mounting evidence suggests this reasoning hasn't actualized, and even thrifty healthcare shoppers don't appear to have any measurable effect on efforts to reduce overall spending, according to The Washington Post.
There are three main reasons high-deductible health plans have failed to cultivate savvy healthcare shoppers, according to the report.
1. When presented with the incentive to lower spending, many consumers simply stop seeing their physicians. Researchers found that high-deductible health plans did corral healthcare spending somewhat, but not for their intended reason. Instead of utilizing price compare tools, researching different providers and avoiding unnecessary procedures, consumers simply reduced their use of healthcare services altogether. They not only avoided superfluous services such as unnecessary imaging scans, but they also skipped out on preventive ones — even the sickest patients who would benefit from them the most. Additionally, after patients reached their deductibles, they stopped cutting back on healthcare.
2. "Smart shopping" yields only limited positive effects. Research from the Health Care Cost Institute suggests thrifty healthcare shopping has the potential to affect only a small proportion of total healthcare spending, according to the report. That is because not all procedures are "shopable" — nonemergency services conducive to spending time comparing prices and providers. Of the ones that are, much "shopable spending" is on co-payments, which are usually relatively the same between providers. Furthermore, patients living in rural areas have a significantly reduced opportunity to shop around.
3. Many people don't know how to access the tools to compare costs. A lack of transparency into pricing poses a significant barrier to would-be savvy shoppers. A survey by Pioneer Institute found that unless people are willing to make multiple phone calls to healthcare providers or they have deep insider knowledge of hospital billing codes, it is unlikely they will be able to discover substantial prices differences and achieve savings, according to the report.
"You can't save and choose wisely in terms of a price, quality combination of healthcare if you don't have the information," said Barbara Anthony, a senior fellow in healthcare at the Pioneer Institute, according to the report. "And so without the information you're in the dark, and that's not way for a market to operate."