By Jill Zorn
Giving consumers “skin in the game” to “shop” for health care through high deductibles and co-pays does not look like a very effective way to control health care costs.
The theory is that health care providers will be forced to compete by offering good quality care at the lowest possible price, thus bringing overall health care costs down.
It seems that this theory is more fiction than fact, as health care journalist Trudy Lieberman wrote in Patients aren’t consumers, but the fiction of the rational health care shopper continues.
One recent study cited by Lieberman shows that even well-educated employees with “state-of-the-art” shopping tools, found that health care expenditures dropped, but that “… nearly the entire decline resulted from an outright reduction in the consumers’ demand for services, rather than from them price shopping or substituting less costly procedures.”
The study also found that these employees were avoiding spending money on needed care. Instead of saving money, this avoidance could lead to higher health care costs down the line by allowing an untreated health problem to worsen.
In mid-January, a study published in the Journal of the American Medical Association came to the same conclusion that high deductibles don’t lead to health care shopping. As reported in Kaiser Health News, the researchers found that, “Even when people were responsible for more of their health costs, they weren’t more likely to consider cost or shop around for the best deal on medical treatments.”
As Consumers Union points out, there is only a very small proportion of health care that is even “shoppable” to begin with. It requires:
- A service that can be scheduled in advance
- More than one provider to choose from
- Price information
- And, ideally, information on the quality of the service
Even in Connecticut, where major transparency efforts are underway through the new health care law, PA 16-146 and the All Payer Claims Database (APCD), we are far from having the price and quality data that we need to be informed shoppers. With provider consolidation accelerating, our choices are becoming more limited. And, as is obvious, much of our health care needs can’t be anticipated and therefore can’t be scheduled.
But, even if all of these conditions were met, it is still doubtful that people would shop, as the studies discussed earlier in this blog show.
Instead, what is happening is that too many people with high deductibles and co-pays are delaying or avoiding care or accumulating medical bills that they can’t afford to pay.
It’s time to put the myth of “skin in the game” as a cure-all for our over-priced, under-performing health care system to rest. As Lieberman puts it, “Just don’t count on 320 million people looking for the cheapest CT scan to lower the high price tag for American health care.”