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
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
“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
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 HealthCare.gov.
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
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,”
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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