Few Customers on High Deductible Plans Engage in Consumer Behaviors

The number of American adults on high-deductible health plans (HDHPs) has risen sharply over the last decade: As of 2016, over 40% of insured 18-64 year olds were on an HDHP, the majority of whom received coverage through their employer. The plans allow patients to pay lower premiums, but leave them on the hook for high costs in the event of illness or injury.

Such patients are often encouraged to become more proactive healthcare consumers by engaging in preventative healthy behaviors and saving money for potential procedures. A new study from researchers at the University of Michigan, however, found that only a minority of high-deductible patients actually do those things.

Using Gfk’s KnowledgePanel, the researchers surveyed a nationally representative population of over 1,600 participants enrolled in HDHPs, oversampling those with chronic conditions (42%). HDHPs were defined as health plans with a deductible of $1300 or more for an individual or at least $2600 for a family. The results were published last week in JAMA Internal Medicine.

Over 80% of respondents received their insurance through their employers, and more than half (58%) had a health savings account. But only 40% of the patients said that they saved for future health services, and only slightly more than half (53%) who did reported that they perceived the practice as helpful when it came to getting a needed health service.

Other positive “consumer behaviors” were utilized even less: 25% reported discussing cost of service with their provider, while 14% reported comparing price or quality, respectively, of drugs and procedures.

With the future of the Affordable Care Act in question, it is likely that HDHPs continue to become more prevalent. Much of the justification for the use of them is based on the potential to reduce waste: The threat of higher out-of-pocket payments should, as proponents argue, encourage patients to make wiser decisions and seek less unnecessary care, creating value throughout the health system.

A study of systemic savings from HDHPs found that they reduced consumer healthcare spending by as much as 13.8%, but that the savings may come from patients avoiding important and necessary medical services just as much as wasteful ones.

The new study adds to evidence that HDHPs don’t inherently encourage patients to become more health-savvy. Another JAMA Internal Medicine study, published in 2016, found that HDHP customers were “no more likely than enrollees in traditional plans to consider going to another health care professional for their care or to compare out-of-pocket cost differences across health care professionals.”

The University of Michigan authors wrote that better price transparency might encourage consumer engagement and proactive behaviors. They also recommended that providers talk with patients about medical procedures they may need in the coming years, so that they can begin to save the money now.