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High deductibles don't make people shop for health care

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The concept behind high-deductible health plans is that if people are on the hook for a larger share of their medical bills, they'll be more likely to consider cost when making health care choices. But a new report finds that people enrolled in high-deductible plans are no more likely than those in traditional plans to shop for affordable care.

Researchers at Harvard and USC conducted a national survey of about 2,000 people; about 1,100 of them had deductibles greater than $1,250 for individuals or above $2,500 for a family. Despite being concerned about costs and aware of cost differences, just 4 percent of people in these high-deductible plans said they compared costs the last time they used medical care. Three percent of those in plans with low deductibles said they had done any cost shopping. 

"High-deductible health plans are sold as a tool through which we can not only save health care dollars, but we can encourage patients to make value-based decisions," says Neeraj Sood, a professor at USC’s Leonard D. Schaeffer Center for Health Policy & Economics and co-author of the study, which was published Tuesday in JAMA Internal Medicine.

"At least in this test, high-deductible health plans fail," he continues. "There's no evidence here that high-deductible health plans encourage people to make value-based decisions."

Past research demonstrates that high-deductible plans are associated with lower health care spending, but these savings are a result of high-deductible enrollees using less health care. Until now, there's been little investigation into whether having one of these plans encourages people to seek out lower-cost care, Sood says.

For Sood and his colleagues, being a smart consumer means shopping around for care. He cites two reasons: There's a lot of variation in the price of certain health care procedures, and there's not a lot of correlation between price and quality.

"It's not that the place that is providing the more expensive health care service is actually a better place," says Sood.

The researchers learned that 60 percent of people with high-deductible plans believe there are large differences in price and quality across health care providers and just 17 percent think physicians who charge higher prices provide higher quality care. Also, 71 percent said out-of-pocket costs are important when choosing a doctor.

People in traditional health plans hold similar views, they found.

Sood says future research should focus on why people with high-deductible health plans aren't shopping for care, even though they understand that they might be able to find a lower-cost option.

One likely reason, he says, is people value continuity of care. He says people tend to think, "even if I can save some money by going to a different doctor, I'm reluctant to do that because I already have an established relationship with my physician."

Another obstacle, says Sood: shopping for health care is inconvenient and challenging.

"Just providing the financial incentives is not enough," he says. "We need to enable better decisions by providing decision aids or making it just more convenient for it to happen."

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