High-Deductible Health Care Enrollees Not More Likely to Seek Cheaper Prices


Study finds decreased spending is not due to enrollees switching to lower cost providers.

High-deductible health plans (HDHP) were found to have been driven by cost-sharing obligations that encourage enrollees to look for cheaper health care costs, in a recent study published in JAMA Internal Medicine.

With the wide spectrum of physician and hospital costs, this provides the opportunity for enrollees to save money by switching to lower-cost providers.

HDHP is a health plan that has an individual deducible higher than $1250, a family deductible more than $2500, or a health plan that includes a health savings account.

It was once believed that HDHP goes hand-in-hand with lower spending, however, researchers found the lower spending was in response to a decrease in use of care and not because enrollees are switching to lower cost providers, as previously thought.

A sample was taken to determine the attitude of enrollees toward shopping around for lower costs when seeking care. The sample looked at price shopping care rates from 1951 adults between the ages of 18 and 64 years in the United States who received medical care in the last year.

These samples compared HDHP enrollees with people who had traditional health care plans by using a generated probability-based random sampling.

Researchers gave patients free internet access in order to survey their thoughts about price shopping, whether they took into account another possible health care professional, or if there was a comparison for out-of-pocket costs with other providers.

Investigators used logistic regression and took into account sociodemographic characteristics.

The results of the study showed that out of the 1951 responders, the overall response rate was 67.6%. There were 1099 patients in the HDHP group and 852 in the non-HDHP group. The HDHP showed a greater amount of people who were employed, had more education, a higher income, and were white.

Among the group of 1099 HDHP enrollees, 659 (60%) individuals felt there was a greater difference in prices and quality across the board in health care providers. Meanwhile, 185 (17%) individuals indicated that higher price physicians gave higher quality care and 774 (71%) individuals said that out-of-pocket costs held more importance than which doctor they chose.

Enrollees in traditional plans only had a slight difference in opinions. Researchers discovered that those in the HDHP group were less likely to believe that higher price facilities gave higher quality care than those in the non-HDHP groups (n = 179 [16%] vs n = 206 [25%]; P = .001).

Individuals in the HDHP group were also more likely to say that out-of-pocket costs are important for radiology facilities (n = 882 [81%] vs n = 598 [74%]; P = .003) than those in the non-HDHP group.

Of the HDHP enrollees, 611 (56%) said they would use other sources of price information for health care if it were made available to them.

Lastly, under their prior medical care, researchers found that HDHP enrollees were not any more likely than enrollees in traditional plans to go to another professional for care (n = 120 [10.9%] vs n = 85 [10.0%]; P = .67) or compare out-of-pocket differences among other health care professionals (n = 42 [3.8%] vs n = 23 [2.7%]; P = .37).

The study did not survey uninsured enrollees or those who did not use medical care.

“If encouraging price shopping is viewed as an important policy goal, then there is a need for greater availability of price information and innovative approaches to enrollee engagement with this information.”

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