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 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,” said Neeraj Sood of the
University of Southern California, Los Angeles.
Sood and colleagues surveyed more than 1,800 insured U.S. adults
ages 18 to 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 percent of both
high-deductible enrollees and those with other plans considered
going to another healthcare professional for care, and only 3 or 4
percent compared out-of-pocket cost differences by provider, the
researchers reported 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.”
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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 wrote.
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, Sood said.
“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 said. “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.”
SOURCE: http://bit.ly/23cwdok JAMA Internal Medicine, online January
19, 2016.
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