Consumers with high-deductible health plans could be smarter shoppers

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[November 28, 2017] By Lisa Rapaport

(Reuters Health) - Even when consumers have health plans that require them to pay a high amount out-of-pocket for care, they often don’t talk to doctors about the price of treatments or shop around to get the best deal, a U.S. study suggests.

Researchers focused on high-deductible health plans, which typically have lower monthly premiums than other types of insurance but require patients to pay more out-of-pocket before the insurance coverage kicks in.

For the study, published online November 27 in JAMA Internal Medicine, researchers surveyed a nationally representative sample of 1,637 adults who had been enrolled in a high-deductible health plan for at least a year. Overall, 42% of participants had at least one chronic health problem and 58% had a savings account to pay for medical expenses.

However, just 40% of these consumers said they were saving for future health services and only 25% reported talking to their doctor about costs, the study found. A mere 14% had tried to compare prices and quality.

“Few Americans in high-deductible health plans are engaging in consumer behaviors,” said lead study author Dr. Jeffrey Kullgren of the VA Ann Arbor Healthcare System and the University of Michigan Medical School.

But when patients did deploy smart consumer behaviors like trying to negotiate prices or comparison shop for the best quality and price for their care, it did help them get needed treatment or pay a lower price, Kullgren said by email.

“Consumers with high deductibles, particularly those who are having trouble affording their care, should consider whether engaging in one or more of these behaviors might be helpful,” Kullgren added.

Under these plans, deductibles are $1,300 for individuals and $2,600 for families. High-deductible plans can be combined with health savings accounts that let patients set aside money to cover medical bills. Funds in the accounts are exempt from federal taxes, according to

Most of the survey participants were employed and had health benefits provided by their employer.

Consumers most often did things to negotiate prices or comparison shop when they were getting prescriptions or outpatient care, the researchers found.

The study wasn’t a controlled experiment designed to prove whether or how certain consumer behaviors might influence the cost or quality of care patients get with high-deductible health plans.

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Even so, the results offer fresh evidence of the complexity of trying to get patients to comparison-shop for medical care the same way they might for a new washing machine or a used car.

“We know consumers respond to high deductibles by reducing care and that consumers don’t necessarily do a good job discriminating between necessary and unnecessary care,” said Joel Segel, a health policy researcher at Pennsylvania State University who wasn’t involved in the study.

Patients with these plans should have health savings accounts, especially if they have chronic health problems that they know will require them to pay a lot of money out of pocket in the future, Segel said by email.

“Patients should also know that if they are having difficulty meeting their medical bills that providers may be willing and have options for negotiations and helping patients afford their care,” Segel added.

These plans also aren’t for everyone, and some people may be better off choosing insurance with higher monthly premiums but lower and less confusing out-of-pocket costs, said Dr. Franklin Wharam, a health policy and insurance researcher at Harvard Medical School in Boston who wasn’t involved in the study.

“Consumers with the time, interest, and resources to shop for good value in health care might thrive under high-deductible health plans,” Wharam said by email. “Others should consider their health benefit type carefully (if their employer offers choices) and choose the plan that optimizes their health and financial situation.”


JAMA Intern Med 2017.

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