“Skin in the game” doesn’t work


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Making people pay more of their health care bill out of pocket does not make them smarter shoppers, according to a new study published in Health Affairs, which corroborates earlier research.

The big picture: Part of the idea behind those ever-increasing insurance deductibles is that patients who have to put more of their own money on the line will become better consumers, comparison-shopping for the highest-quality, lowest-cost services.

  • But it doesn’t seem to work that way in the real world.

What they’re saying: In the Health Affairs survey of people with high-deductible plans …

  • Just 25% had talked to their provider about how much something would cost.
  • 14% had compared prices at multiple facilities.
  • 14% had compared quality metrics for multiple facilities.
  • 7% had tried to negotiate a price.

Between the lines: People don’t do these things because they don’t even think of it, or assume it won’t work. Or, to borrow some truly glorious academic-speak: “Perceptions of futility were common impediments to engagement.”

  • separate study, also published in Health Affairs, did find one effect of high deductibles: They seem to make women more likely to delay treatment for breast cancer.

Yes, but: There’s some evidence that if patients try to avail themselves of comparison-shopping tools, they can achieve real savings, at least for MRIs and other imaging procedures.


The High Toll of High-Deductible Health Care Plans


Bloomberg looks at an important trend in health care coverage: the rise of employer-based high-deductible plans that mean many patients and families simply can’t afford to get sick.

Some companies are now rethinking those policies, Bloomberg’s John Tozzi and Zachary Tracer report, after realizing that their goal of reducing costs by getting patients to have more “skin in the game” instead led workers to delay or forgo care, including medications. Patients didn’t become “better” health-care consumers. They simply cut back on what they thought they couldn’t afford — potentially driving up costs in the long run.

“High-deductible plans do reduce health-care costs, but they don’t seem to be doing it in smart ways,” said Neeraj Sood, director of research at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California.

The trend: Nearly 40 percent of large employers offer only high-deductible plans, up from 7 percent in 2009, according to a survey by the National Business Group on Health cited by Bloomberg. And half of all covered workers now have a deductible of at least $1,000 for an individual, up from 34 percent in 2012 and 22 percent in 2009, according to the Kaiser Family Foundation. Nearly one in four covered workers has a deductible of $2,000 or more.

The key quote: “Why did we design a health plan that has the ability to deliver a $1,000 surprise to employees?” Shawn Leavitt, a senior human resources executive at Comcast, said at a recent conference, according to Bloomberg. “That’s kind of stupid.”

Why it matters: As employers move away from simply shifting more and more costs to their workers, Axios’ Sam Baker notes, they’re also paying more attention to bringing down underlying health care prices .