High-deductible health plans are supposed to encourage consumersto shop around for cheaper health care services or put money awayto pay for what they need. But it's not working that way, accordingto a new study published in JAMA Internal Medicine by a team from theUniversity of Michigan Institute for Healthcare Policy andInnovation.

An Insurance Journal report says that even though such plans are becoming more common, workers with high-deductible health plans aren’t taking anyof the actions one might expect them to take—from actually puttingmoney into an HDHP savings account to checking for the best pricesto trying to negotiate better rates, or even just talking to their doctors about costs. And evenwhen they do, they’re not getting the help they need.

“Most Americans in HDHPs are not doing things that can help themget the care they need at the lowest possible cost, and even thosewho are doing so could realize more benefits,” Jeffrey Kullgren,M.D., M.S., M.P.H., an assistant professor of general medicine atU-M and lead author of the study, says in the report.

According to the Centers for Disease Control and Prevention,more than 40 percent of American adults have an HDHP. Such plansrequire individuals to pay at least the first $1,300 of their owncosts and families the first $2,600, and are usually offered with atax-protected health savings account aimed at providing a place forpeople to save for future health care expenses.

But they’re not working that way. Even though their advocatessay that such plans are a way to give patients “skin in the game”and make them play a more active role in keeping costs down fortheir own care, researchers say that many people aren’t pursuing“consumer” behaviors such as saving, negotiating costs withproviders and researching quality ratings—even among patients withchronic health conditions.

And the disconnects are pretty big. For instance, overall, 58percent of poll participants said they had an account to put asidemoney for medical expenses, including HSAs. But only 40 percent ofthe entire sample had actually saved any money in those accounts.Just 25 percent had talked to a healthcare provider about the costof a service, and a scant 14 percent had compared prices for thesame service or product, or the quality ratings for differentproviders.

Fewest of all were the brave souls who tried to bargain onprices; only 6 percent had tried to negotiate the price of a healthcare service, either in advance or after they received a bill for aservice they’d received.

Even more discouraging, just 45 percent of those who hadcompared prices said it had actually helped them pay less for aservice. Among those who had talked to a provider about cost,two-thirds had done it for prescription medicines, but only 45percent said that having done so had helped them get care theyneeded.

In the report, Kullgren notes that other research indicates thatpeople in HDHPs often use less health care than people with othertypes of insurance. But—and it’s a big but—they also use less ofthe care that might be most effective for them, as well asless-effective care that they probably don’t need.

The researchers conclude that health care providers, insurersand employers could do more to help people in HDHPs, such asproviders helping patients to understand possible future needs forwhich they should save; health care facilities making pricesavailable at the point of care so that patients and providers cantalk about cost; and employers offering HDHPs providing more thanjust price information so that employees learn how to use thisinformation when making decisions.