Researchers have found evidence that increasing consumers’ out-of-pocket health care costs may really mobilize them to make providers more budget-conscious.
Paul Fronstin, an analyst at the Employee Benefit Research Institute (EBRI), and Anne Elmlinger, an analyst at Greenwald & Associates, have published figures supporting the power of “skin in the game” in a report based on data from an Internet survey of about 2,000 U.S. adults with commercial health coverage.
Consumers who had high major medical deductibles were much likely to say they had engaged in cost-control strategies such as talking to doctors about prescription drug costs and about treatment options and costs than patients with low deductibles were.
Only 29 percent of the participants with low-deductible coverage said they had asked doctors to prescribe less costly drugs, and just 31 percent said they had talked to doctors about other types of treatment options and costs.
About 39 percent of the participants with “consumer-driven health plans” (CDHPs) — deductibles of at least $1,300 for an individual or $2,600 for a family, along with a health savings account (HSA) or health reimbursement arrangement (HRA) — said they had asked doctors to prescribe cheaper drugs, and 36 percent said they asked doctors about treatments options and costs.
The skin-in-the-game factor was even stronger for the survey participants with high-deductible health plan (HDHP) coverage and no personal health accounts: About 40 percent had asked for cheaper drugs, and 40 percent had had conversations with doctors about treatment options and costs.
The survey participants were all ages 21 to 64. They all had group coverage, off-exchange individual coverage, or commercial coverage purchased through a Patient Protection and Affordable Care Act (PPACA) exchange.
In some earlier surveys, EBRI researchers seemed skeptical about how much increasing enrollees’ out-of-pocket costs really affected enrollees’ efforts to hold down health care costs. The results of some EBRI surveys implied that the shopping tools available to traditional plan enrollees might be about as good as the tools available to CDHP enrollees.
In the new report, there are signs of a retreat from the high-deductible strategy.
The percentage of participants with HDHP coverage held steady at 11 percent, but the percentage with CDHP coverage fell to 13 percent, from 15 percent in 2014. The percentage with traditional coverage increased to 76 percent, from 74 percent.
CDHP users were about as likely or less likely as traditional coverage holders to say they had sought information about most types of care before getting the care.
The HDHP users were noticeably more likely than other consumers to say they had tried in advance to get the cost of prescription drugs, lab or radiology tests, outpatient procedures, inpatient surgery, mental health care and alternative medical care.
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